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Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis: The Multicenter HATTUSHA Study.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2022 Mar 15; Vol. 79 (10), pp. 977-989. - Publication Year :
- 2022
-
Abstract
- Background: 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.<br />Objectives: This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT.<br />Methods: 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.<br />Results: 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).<br />Conclusions: 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.<br />Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.<br /> (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Female
Fibrinolytic Agents adverse effects
Fibrinolytic Agents therapeutic use
Humans
Male
Middle Aged
Thrombolytic Therapy adverse effects
Thrombolytic Therapy methods
Tissue Plasminogen Activator adverse effects
Tissue Plasminogen Activator therapeutic use
Treatment Outcome
Heart Valve Diseases complications
Heart Valve Prosthesis adverse effects
Thrombosis complications
Thrombosis etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1558-3597
- Volume :
- 79
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 35272803
- Full Text :
- https://doi.org/10.1016/j.jacc.2021.12.027