Department of Cardiology, Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Physiology, Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Card Surg. 2022 Sep;37(9):2776-2785. doi: 10.1111/jocs.16681. Epub 2022 Jun 14.
Prosthetic valve thrombosis (PVT) is a rare but life-threatening complication. Surgery and fibrinolytic therapy (FT) are the two main treatment options for PVT. The choice between surgery and FT has always been a matter of debate. Previous studies have shown that although the mortality rate is higher in surgery, complications are less frequent than in FT. We aimed to perform a systematic review and meta-analysis to compare the results of surgery and FT in PVT.
A systematic review of the literature was performed through Medline, Embase, Scopus, and Web of Science, encompassing all studies comparing surgery and FT in PVT. The rate of each complication and risk ratio (RR) of complications in surgery and FT were assessed using random-effects models.
Fifteen studies with 1235 patients were included in the meta-analysis. The pooled risk of the mortality was not significantly different between FT and surgery in patients with PVT (pooled RR = 0.78, 95% confidence interval [CI]: 0.38-1.60, I² = 61.4%). The pooled risks of thromboembolic events (pooled RR = 4.70, 95% CI: 1.83-12.07, I² = 49.6%) and major bleeding (pooled RR = 2.45, 95% CI: 1.09-5.50, I² = 41.1%) and PVT recurrence (pooled RR = 2.06 95% CI: 1.29-3.27, I² = 0.0%) were significantly higher in patients who received FT.
Surgery may be safer and with fewer complications than FT for PVT treatment. However, randomized clinical trials are needed to determine the proper treatment for PVT.
人工瓣膜血栓形成（PVT）是一种罕见但危及生命的并发症。手术和纤维蛋白溶解治疗（FT）是治疗 PVT 的两种主要选择。手术和 FT 之间的选择一直存在争议。先前的研究表明，尽管手术的死亡率较高，但并发症的发生率低于 FT。我们旨在进行系统评价和荟萃分析，以比较 PVT 中手术和 FT 的结果。
通过 Medline、Embase、Scopus 和 Web of Science 进行系统的文献回顾，纳入比较 PVT 中手术和 FT 的所有研究。使用随机效应模型评估手术和 FT 中每种并发症的发生率和并发症风险比（RR）。
荟萃分析纳入了 15 项研究共 1235 例患者。PVT 患者中，FT 和手术的死亡率无显著差异（合并 RR=0.78，95%置信区间[CI]：0.38-1.60，I²=61.4%）。FT 组血栓栓塞事件（合并 RR=4.70，95%CI：1.83-12.07，I²=49.6%）、大出血（合并 RR=2.45，95%CI：1.09-5.50，I²=41.1%）和 PVT 复发（合并 RR=2.06，95%CI：1.29-3.27，I²=0.0%）的风险明显高于手术组。
对于 PVT 的治疗，手术可能比 FT 更安全，并发症更少。然而，需要随机临床试验来确定 PVT 的适当治疗方法。
