Management and Clinical Outcomes in Patients with Mechanical Tricuspid Valve Thrombosis

Abstract

Background: The incidence of prosthetic tricuspid valve (TV) thrombosis is the highest among heart valves. It can lead to high morbidity and mortality without proper treatment. In this study we sought to report the management and clinical outcomes of patients with mechanical TV thrombosis. Methods: In in a retrospective single-center study, all patients with mechanical TV thrombosis were evaluated from 2006 to 2017. The data on baseline characteristics, management of mechanical TV thrombosis, and the rates of adverse events during follow-up period were assessed. Results: A total of 67 episodes of mechanical TV thrombosis in 42 patients were observed. The mean age of patients was 45.5±14.3 years (19 to 77), and overall two-thirds were female. Thrombolytic therapy (TT) was used in 41 (61.1%), anticoagulant intensification in 15 (22.3%), and surgery as first approach in 11 (16.4%) episodes; subsequently, surgery as the final approach was implemented in 20 (29.8%) episodes. There were a total of 2 (2.98%) in-hospital deaths. Moreover, 2 (4.87%) episodes of retroperitoneal hematoma and 1(2.43%) episode of non-hemorrhagic thalamic infarct in TT group, and 1 (5%) episode of non-hemorrhagic stroke following surgery were developed. The rates of freedom from recurrent thrombosis were 84%, 61%, and 21% at the end of 2, 4, and 10 years, respectively. Survival rates and freedom from chronic valve dysfunction was 93%, 82%, and 75% after 1, 4, and 10 years. Conclusions: The recurrent thrombosis requiring intervention is a major complication of mechanical TV, which underscores individual-approached therapy and close follow-up to improve outcome.

A case of early thrombosis following a percutaneous tricuspid valve in valve implantation managed by thrombolysis

“…In a therapeutic outcome study for tricuspid mechanical valve thrombosis, 41 patients received fibrinolytic therapy without intracranial or gastrointestinal bleeding and two episodes of retroperitoneal bleeding. The success rate was 84% 11 . The other study compared five thrombolytic regimens for treatment of prosthetic valve thrombosis, including 10 cases of the mechanical tricuspid valve, reported an 85% overall success rate for ultra-slow infusion of alteplase and the lowest complication rate compared to the other regimens.…”