Evaluation of response to thrombolytic therapy versus surgery in patients with aortic prosthetic valve thrombosis in a tertiary heart center in Tehran, Iran, during 2007–2019

Background: Prosthetic valve thrombosis is of the serious long-term complications of heart valve replacement that its treatment particularly in left-sided valves is controversial. Both surgery and thrombolysis are associated with their own merits and drawbacks. Hence, the aim of the present study is the evaluation of response to surgery and thrombolytic therapy in patients with aortic prosthetic valve thrombosis in a tertiary heart center in Tehran, Iran, during 2007–2019. Materials and Methods: In this retrospective study, 85 patients with aortic prosthetic valve thrombosis (including 63 case of surgery and 22 case of thrombolytic therapy) were evaluated. Response to clinical and hemodynamic treatment and frequency of complications and mortality were determined in each group. Results: Clinical complete response in surgery group (84.13%) was significantly more than patients with thrombolytic therapy (64.63%). The frequency of complications in surgery and the thrombolytic group was 12.7% and 9.09%, respectively, which show no significant difference. Mortality was seen in 1.58% and 4.53% of patients with surgery and thrombolytic therapy respectively that was not statistically significant. Complete failure of treatment was seen in 18.18% of patients with thrombolytic therapy and re-surgery was done for them. The surgery success rate was significantly more than thrombolytic success rate in patients with a therapeutic range of international normalized ratio (INR) level. Conclusion: Surgery versus thrombolytic therapy has more efficacy and similar safety in patients with aortic prosthetic valve thrombosis and may be preferable treatment for these patients. However, thrombolytic therapy also can be used as a suitable alternative, particularly in patients with a high risk of surgery.