Surgery Versus Thrombolytic Therapy for the Management of Left-Sided Prosthetic Valve Thrombosis Without Hemodynamic Compromise: A Systematic Review and Meta-Analysis

• Published in: Journal of the American Heart Association 2024-10, Vol.13 (19), p.e035143
• Main Authors: Chopard, Romain, Vidoni, Charles, Besutti, Matthieu, Ismail, Maria, Ecarnot, Fiona, Favoulet, Baptiste, Badoz, Marc, Schiele, François, Perrotti, Andrea, Meneveau, Nicolas
• Format: Article
• Language: English
• Subjects: Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Female; Fibrinolytic Agents - therapeutic use; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Hemodynamics - drug effects; Humans; Male; meta‐analysis; Original Research; prosthetic valve thrombosis; surgery; thrombolysis; Thrombolytic Therapy - methods; Thrombosis - drug therapy; Thrombosis - etiology; Thrombosis - surgery; Treatment Outcome
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.124.035143

The optimal strategy in prosthetic heart valve thrombosis (PVT) remains controversial, with no randomized trials and conflicting observational data. We performed a systematic review and meta-analysis of evidence comparing systemic thrombolysis and cardiac surgery in PVT. We searched PubMed, the Cochrane Library, and Embase for studies on treatment strategies in patients with left-sided PVT since 2000. The primary outcome was death, and the secondary outcomes were major bleeding and thromboembolism during follow-up (International Prospective Register of Systematic Reviews No. CRD42022384092). We identified 2298 studies, of which 16 were included, comprising 1389 patients with PVT (mean age, 50.4±9.3 years; 60.0% women). Among them, 67.2% were New York Heart Association stage III/IV at admission. Overall, 48.1% were treated with systemic thrombolysis and 51.9% with cardiac surgery. The mortality rate was 10.8% in the thrombolysis group and 15.3% in the surgery group. The pooled risk difference for death with systemic thrombolysis was 1.13 (exact CI, 0.74-1.79; =0.89;