Management of prosthetic valve thrombosis

Fibrinolysis and surgery with either valvular re-replacement or thrombectomy are both established therapies for prosthetic valve thrombosis. In both treatment strategies, the complication rate depends to a similar degree on pre-interventional clinical and haemodynamic status. Fibrinolysis serves to avoid a second operation, but the incidence of recurrent thrombosis is higher. Before deciding in favour of thrombolytic therapy, structural defects of the prosthetic valve or tissue in-growth, which increase the risk of rethrombosis, should be ruled out by transoesophageal echocardiography. Apart from those cases in which there are contraindications to either treatment, we recommend surgery in cases of underlying prosthetic valve dysfunction or recurrent thrombosis.