Tolah Majed, Alharbi Ibraheem H, Sandogji Hasan I, Abdelrehim Ayman, Lami Nouf, Alkhalaf Thikra, Fallatah Albaraa, Utuanis Shyelene, Shabaan Ahmed
Madina Cardiac Center, Madinah, Saudi Arabia.
Ministry of Health, Madinah, Saudi Arabia.
Egypt Heart J. 2025 Mar 18;77(1):31. doi: 10.1186/s43044-025-00627-1.
Obstructive prosthetic valve thrombosis is a life-threatening complication associated with high morbidity and mortality. Evaluation of outcomes of surgical management and identification of the perioperative variables associated with poor prognosis are necessary to provide appropriate interventions.
We conducted a retrospective analysis of 39 patients who underwent redo surgery for obstructive prosthetic valve at the Madinah Cardiac Center, Saudi Arabia. Between January 2017 to October 2023 Preoperative, intraoperative, and postoperative factors that influenced the outcome were analyzed. The nature of the obstructed valve was commonly mechanical (32/39, 82.1%) located in the mitral position (30/39, 76.9%) which occurred due to thrombosis, and the size of the thrombus was more than 1 cm in 27 (69.2%) patients. High percentage (25/39, 64.1%) of the patients had a suboptimal INR (less than 2). The major postoperative complications were respiratory failure (6/39, 15.4%) and dysrhythmias (20/39, 51.3%). The 30-day postoperative mortality was 7.7% (3/39). Patients who underwent surgery after failed thrombolysis had significantly higher mortality than those who underwent direct surgery (p = 0.018).
Prosthetic valve thrombosis is primarily associated with suboptimal anticoagulant therapy and can occur years after valve replacement surgery. The prognosis for redo valve replacement is favorable with a 30-day operative mortality rate of 7.7%. For patients with prosthetic valve thrombosis, direct surgical intervention without prior fibrinolysis may be safe and effective for patients with prosthetic valve thrombosis.
人工瓣膜阻塞性血栓形成是一种危及生命的并发症，具有较高的发病率和死亡率。评估手术治疗的结果并确定与预后不良相关的围手术期变量对于提供适当的干预措施是必要的。
我们对沙特阿拉伯麦地那心脏中心39例行人工瓣膜阻塞性血栓形成再次手术的患者进行了回顾性分析。分析了2017年1月至2023年10月期间影响手术结果的术前、术中和术后因素。阻塞瓣膜的类型通常为机械瓣膜（32/39，82.1%），位于二尖瓣位置（30/39，76.9%），由血栓形成引起，27例（69.2%）患者的血栓大小超过1厘米。高比例（25/39，64.1%）的患者国际标准化比值（INR）不理想（低于2）。主要术后并发症为呼吸衰竭（6/39，15.4%）和心律失常（20/39，51.3%）。术后30天死亡率为7.7%（3/39）。溶栓失败后接受手术的患者死亡率显著高于直接手术的患者（p = 0.018）。
人工瓣膜血栓形成主要与抗凝治疗不理想有关，可在瓣膜置换术后数年发生。再次瓣膜置换术的预后良好，30天手术死亡率为7.7%。对于人工瓣膜血栓形成患者，未经预先溶栓的直接手术干预可能对患者安全有效。
