Outcomes After Percutaneous Transcatheter Release or Fibrinolysis for Obstructive Mechanical Mitral Valve Thrombosis

Currently, surgery and fibrinolysis are the two class-I recommendations to manage obstructive mechanical mitral valve thrombosis (OMMVT). Percutaneous transcatheter release of a stuck mechanical valve (PETROS) with cerebral embolic protection (CEP) for OMMVT is suggested when neither of the above treatment options can be offered. This study estimated the 1-year clinical outcomes of the PETROS and fibrinolysis. The primary outcome was 1-year all-cause death. The secondary outcomes included technical success and the 1-year stroke, recurrence and redosurgery. Between January 2019 and April 2024, 123 consecutive patients with OMMVT were evaluated. Out of them, 32 underwent PETROS, and 70 received fibrinolysis. All patients were followed up for one year. In the PETROS group, 1-year survival was 87.50% (95%CI: 70% - 95.10%, and technical success was achieved 93.75% of patients. The cumulative incidence of 1year stroke, recurrence, and redo surgery was 6.25% (95% CI: 1.10%-18.10%), 20% (95% CI: 8.10%-35.60%), and 6.25% (95% CI: 1.10%-18.10%), respectively. In the Fibrinolysis group, 1-year survival was 79.60% (95%CI: 68% - 87.40%, and technical success was achieved in 54.28%. The cumulative incidence of 1year stroke, recurrence, and redo surgery was 10.19% (95% CI: 4.50%-18.70%), 24.68%(95% CI: 12.30%-39.40%), and 10.39% (95% CI: 4.60%-19%), respectively. In conclusion, PETROS with CEP appears to be a promising treatment option for selected high-risk patients with OMMVT in whom surgery and fibrinolysis are contraindicated or after failed fibrinolysis, with high technical success and acceptable 1-year clinical outcomes.