Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey; Ardahan University, Faculty of Health Sciences, Ardahan, Turkey.
Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
J Am Coll Cardiol. 2022 Mar 15;79(10):977-989. doi: 10.1016/j.jacc.2021.12.027.
Prosthetic valve thrombosis (PVT) is one of the life-threatening complications of prosthetic heart valve replacement. Due to the lack of randomized controlled trials, the optimal treatment of PVT remains controversial between thrombolytic therapy (TT) and surgery.
This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT.
A total of 158 obstructive PVT patients (women: 103 [65.2%]; median age 49 years [IQR: 39-60 years]) were enrolled in this multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery.
The initial management strategy was TT in 83 (52.5%) patients and surgery in 75 (47.5%) cases. The success rate of TT was 90.4% with a median t-PA dose of 59 mg (IQR: 37.5-100 mg). The incidences of outcomes in surgery and TT groups were as follows: minor complications (29 [38.7%] and 7 [8.4%], respectively), major complications (31 [41.3%] and 5 [6%], respectively), and the 3-month mortality rate (14 [18.7%] and 2 [2.4%], respectively).
Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT.
人工心脏瓣膜血栓形成（PVT）是人工心脏瓣膜置换术后危及生命的并发症之一。由于缺乏随机对照试验，溶栓治疗（TT）和手术之间的 PVT 最佳治疗方法仍存在争议。
本研究旨在前瞻性评估 TT 和手术作为梗阻性 PVT 患者一线治疗策略的结果。
共纳入 158 例梗阻性 PVT 患者（女性 103 例[65.2%]；中位年龄 49 岁[IQR：39-60 岁]）。该多中心前瞻性观察研究中，TT 主要采用低剂量组织型纤溶酶原激活剂（t-PA）（25mg）缓慢（6 小时）和/或超缓慢（25 小时）输注（25mg），多次重复输注。研究的主要终点是 TT 或手术后 3 个月的死亡率。
初始治疗策略为 TT 83 例（52.5%），手术 75 例（47.5%）。TT 的成功率为 90.4%，t-PA 剂量中位数为 59mg（IQR：37.5-100mg）。手术组和 TT 组的结果发生率如下：轻微并发症（29[38.7%]和 7[8.4%]）、主要并发症（31[41.3%]和 5[6%]）、3 个月死亡率（14[18.7%]和 2[2.4%]）。
低剂量和缓慢/超缓慢 t-PA 输注与低并发症和死亡率以及高成功率相关，应考虑作为梗阻性 PVT 患者的可行治疗方法。
