Comparison of Fibrinolytic versus Surgical Therapy in the Treatment of Obstructive Prosthetic Valve Thrombosis: A Single-Center Experience

2011 ◽  
Vol 14 (2) ◽  
pp. 87 ◽  
Author(s):  
Necip Ermis ◽  
Hakan Atalay ◽  
Hakan Altay ◽  
Muhammet Bilgi ◽  
Suleyman Binici ◽  
...  
Keyword(s):  
New York ◽  
Prosthetic Heart Valve ◽  
Heart Association ◽  
International Normalized Ratio ◽  
Fibrinolytic Therapy ◽  
Surgical Approaches ◽  
Specific Patient ◽  
Single Center Experience ◽  
Surgery Group ◽  
Valve Thrombosis

Objective: Prosthetic heart valve thrombosis (PVT) is a rare but severe cardiac condition. There are only a few data regarding comparison of the fibrinolytic and surgical approaches for the treatment of PVT. In this study, we compared the results of fibrinolytic therapy versus surgery in patients who presented to our institution with a diagnosis of obstructive-type PVT.Methods: From January 2001 to August 2008 in our institution, 33 patients who met clinical and echocardiographic criteria for obstructive-type PVT were included in the study. Fifteen of these patients underwent fibrinolytic treatment with streptokinase, which consisted of an initial bolus of 250,000 U followed by 100,000 U/h. Eighteen patients were treated with surgery.Results: The 2 groups had similar baseline characteristics, including New York Heart Association functional status, types and positions of prosthetic valves, international normalized ratio values, and presentation symptoms. Full hemodynamic success was achieved in 12 patients who underwent fibrinolytic therapy and in 15 patients in the surgery group. The mean (SD) streptokinase infusion time was 17.8 11.1 hours. Two major hemorrhages and 2 cases of systemic embolism were observed in the fibrinolytic group. The 2 groups did not differ with respect to mortality rate (P = .79). The duration of hospitalization was longer in the fibrinolytic group than in the surgery group (10.7 6.6 days versus 6.9 6.7 days, P = .045).Conclusions: Although fibrinolytic therapy is generally recommended for the treatment of PVT for specific patient groups, our results suggest that it may be as efficacious and safe as surgery, depending on patient selection.

Safety of thrombolytic therapy in patients with prosthetic heart valve thrombosis who have high international normalized ratio levels

2020 ◽  
Vol 35 (10) ◽  
pp. 2522-2528 ◽  
Author(s):  
Khadijeh Farzaneh ◽  
Seyedeh Hamideh Mortazavi ◽  
Alireza Oraii ◽  
Kyomars Abbasi ◽  
Abbas Salehi Omran ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Heart Valve ◽  
Prosthetic Heart Valve ◽  
International Normalized Ratio ◽  
Valve Thrombosis ◽  
Heart Valve Thrombosis

Prolonged Infusions of Low-Dose Thrombolytics in Elderly Patients With Prosthetic Heart Valve Thrombosis

2016 ◽  
Vol 23 (3) ◽  
pp. 241-247 ◽  
Author(s):  
Sabahattin Gündüz ◽  
Mehmet Özkan ◽  
Mahmut Yesin ◽  
Macit Kalçık ◽  
Mustafa Ozan Gürsoy ◽  
...  
Keyword(s):  
Adverse Events ◽  
Elderly Patients ◽  
Low Dose ◽  
Treatment Success ◽  
Prosthetic Heart Valve ◽  
Heart Association ◽  
Success Rates ◽  
Operating Characteristics ◽  
Valve Thrombosis ◽  
Slow Infusion

Background: The outcomes of thrombolytic therapy (TT) in elderly patients with prosthetic valve thrombosis (PVT) have not been evaluated previously. We investigated the outcomes of low-dose and slow infusion TT strategies in elderly patients with PVT. Methods: Twenty-seven (19 female) patients aged ≥65 years (median: 70 years, range: 65-82 years) were treated with repeated TT agents for PVT. The TT regimens included 24-hour infusion of 1.5 million units of streptokinase in 2 patients, 6-hour infusion of 25 mg recombinant tissue plasminogen activator (t-PA) in 12 patients, and 25-hour infusion of 25 mg t-PA in 13 patients. Treatment success and adverse event rates were assessed. Results: The initial and cumulative success rates were 40.7% and 85.2%, respectively. Adverse events occurred in 6 (22.2%) patients including 4 (14.8%) major (1 death, 1 rethrombosis, and 2 failed TT) and 2 (7.4%) minor (1 transient ischemic attack and 1 access site hematoma) events. Higher thrombus burden (thrombus area ≥1.1 cm2 by receiver operating characteristics analysis, sensitivity: 83.3%, specificity: 85%, area under the curve: 0.86, P = .008) and New York Heart Association class (0% vs 15.4% vs 25% vs 100% for classes I-IV, respectively, P = .02) predicted adverse events. By multiple variable analysis, thrombus area was the only independent predictor of adverse events (odds ratio: 13.8, 95% confidence interval: 1.02-185, P = .04). Conclusion: Slow infusion of low doses of TT agents (mostly t-PA) with repetition is successful and safe in elderly patients with PVT. However, excessive thrombus burden may predict adverse events.

scholarly journals Severe Vascular Complications Following Thrombolytic Therapy in a Case of Prosthetic Mitral Valve Thrombosis – A Case Report

2021 ◽  
Vol 10 (14) ◽  
pp. 1035-1038
Author(s):  
Ayan Husain ◽  
Shilpa Abhay Gaidhane ◽  
Priti Abhay Karadbhajane ◽  
Sourya Acharya ◽  
Apoorva Nirmal
Keyword(s):  
Thrombolytic Therapy ◽  
Prosthetic Valve ◽  
Prosthetic Heart Valve ◽  
Vascular Complications ◽  
Mechanical Valve ◽  
Fibrinolytic Therapy ◽  
Prosthetic Valve Thrombosis ◽  
Valve Thrombosis ◽  
Prosthetic Mitral Valve ◽  
Immediate Surgery

Prosthetic cardiac valve thrombosis is a rare but dangerous complication; 1,2 particularly in patients with low conformity on anticoagulant therapy. Thromboembolic problems happen after mechanical valve substitution in 0.5 - 8 percent. 3-5 Fibrinolytic therapy to treat the thrombosis is widely used nowadays with high efficacy and no severe side effects as compared to emergency surgical treatment, which is associated with high mortality.6 Surgical valve repair in patients with rheumatic heart disease remains the gold standard for the treatment. Thrombosis of the prosthetic heart valve in patients undergoing valve replacement, is the most severe and deadly complication. Currently, the treatments available for symptomatic prosthetic valve thrombosis are immediate surgery or thrombolytic therapy (TT). In rural hospital settings patients are poor and there is a lack of surgical expertise. These factors make TT the perfect treatment for prosthetic valve thrombosis. But one should be aware of embolic complications.

scholarly journals Final 5-year outcomes following aortic valve replacement with a RESILIA™ tissue bioprosthesis

2020 ◽  
Author(s):  
Krzysztof Bartus ◽  
Radoslaw Litwinowicz ◽  
Agata Bilewska ◽  
Maciej Stapor ◽  
Maciej Bochenek ◽  
...  
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Heart Association ◽  
Effective Orifice Area ◽  
Class Iii ◽  
Clinical Trial Registration ◽  
Structural Valve Deterioration ◽  
Valve Thrombosis ◽  
New York Heart Association

Abstract OBJECTIVES Long-term durability of bioprosthetic valves is predominantly limited by structural valve deterioration. RESILIA™ tissue has exhibited reduced calcification in pre-clinical and early clinical studies. This study evaluated the 5-year clinical and haemodynamic outcomes of an aortic valve with this tissue. METHODS This was a prospective, non-randomized, single-arm study of 133 patients implanted with a RESILIA aortic bioprosthesis between July 2011 and February 2013 at 2 sites in Poland. Clinical outcomes and haemodynamic performance were assessed annually for 5 years post-implant. Safety events were adjudicated by a Clinical Events Committee and echocardiographic data were assessed by an independent core laboratory. RESULTS Mean patient age was 65.3 ± 13.5 years, with 34 patients (25.6%) ≤60. The mean follow-up was 4.2 ± 1.5 years. Early (≤30 days) and late (>30 days) all-cause mortality were 2.3% (N = 3) and 3.2%/late patients-years (N = 18) respectively. Early events included thromboembolism in 3 patients (2.3%). Late valve-related events included endocarditis in 1 patient, which led to explant, and valve thrombosis in another patient. There were no events of structural valve deterioration throughout the study. At 5 years, mean gradient was 14.8 ± 7.6 mmHg and effective orifice area was 1.4 ± 0.5 cm2, a marked improvement over baseline values. All New York Heart Association class III patients and most class II patients at baseline had improved classifications at 5 years. CONCLUSIONS The bioprosthesis with RESILIA tissue demonstrated a good safety profile with excellent haemodynamic performance over 5 years of follow-up. These encouraging outcomes warrant additional investigation of this novel tissue. Clinical trial registration number NCT01651052

Assessment of Anti-Tissue Type Plasminogen Activator Antibodies in Patients With Prosthetic Heart Valve Thrombosis

2015 ◽  
Vol 21 (4) ◽  
pp. 372-380 ◽  
Author(s):  
Mehmet Özkan ◽  
Macit Kalçık ◽  
Mustafa Ozan Gürsoy ◽  
Lütfi Öcal ◽  
Samantha Griffini ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Prosthetic Heart Valve ◽  
International Normalized Ratio ◽  
Tissue Type ◽  
Enzyme Linked Immunosorbent Assay ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Valve Thrombosis ◽  
Heart Valve Thrombosis

Background: Thrombolysis is an effective treatment strategy for prosthetic valve thrombosis (PVT). Recombinant tissue-type plasminogen activator (rt-PA) is widely used as a thrombolytic agent. Infusion of rt-PA may trigger the production of anti–tissue plasminogen activator (tPA) antibodies (ATAs). We aimed to evaluate the possible relationship between ATA levels and PVT formation, and the role of baseline ATA levels on outcomes of thrombolytic therapy in patients with PVT. Methods: This prospective, single-center cohort study included 28 patients with PVT undergoing thrombolysis and 31 controls with normal prostheses. Plasma samples were collected from patients with PVT at baseline and at 15th, 30th, 90th, and 180th days after thrombolysis and from controls at baseline only. The ATA levels were assessed in human plasma by an enzyme-linked immunosorbent assay. Results: Baseline ATA-immunoglobulin (Ig) G and IgM were significantly higher in patients with PVT than in controls. The levels of IgM and IgG peaked at 15th and 30th days after rt-PA infusion, respectively. Subtherapeutic international normalized ratio and baseline ATA-IgM were independent predictors of PVT. Thrombolysis failed in 6 patients (21%) in whom baseline IgM levels were significantly higher than successfully lysed patients. Rethrombosis occurred in 9 patients (32%) in whom baseline IgG levels were significantly higher than those without rethrombosis. There was a moderate positive correlation between baseline and 15th-day IgM levels and the dose of rt-PA needed for successful lysis. Conclusion: The ATA levels tended to be higher in patients with PVT at the time of initial diagnosis compared to controls without PVT. In addition, such patients with PVT and high ATA levels may be at high risk for failed thrombolysis or rethrombosis.

Illness Perception and Its Changes During Six Months After Cardiac Rehabilitation

2019 ◽  
Vol 26 (3) ◽  
pp. 90-100
Author(s):  
Justė Lukoševičiūtė ◽  
Kastytis Šmigelskas
Keyword(s):  
New York ◽  
Social Factors ◽  
Nyha Class ◽  
Illness Perception ◽  
Heart Association ◽  
Class Iii ◽  
Cognitive Representations ◽  
Coronary Syndrome ◽  
Type D ◽  
New York Heart Association

Abstract. Illness perception is a concept that reflects patients' emotional and cognitive representations of disease. This study assessed the illness perception change during 6 months in 195 patients (33% women and 67% men) with acute coronary syndrome, taking into account the biological, psychological, and social factors. At baseline, more threatening illness perception was observed in women, persons aged 65 years or more, with poorer functional capacity (New York Heart Association [NYHA] class III or IV) and comorbidities ( p < .05). Type D personality was the only independent factor related to more threatening illness perception (βs = 0.207, p = .006). At follow-up it was found that only self-reported cardiovascular impairment plays the role in illness perception change (βs = 0.544, p < .001): patients without impairment reported decreasing threats of illness, while the ones with it had a similar perception of threat like at baseline. Other biological, psychological, and social factors were partly associated with illness perception after an acute cardiac event but not with perception change after 6 months.

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