3-3-3 Surgery
Surgical Procedures included valve replacement with either a new mechanical or a bioprosthetic valve (n = 18, 90%), and previous valve cleaning (n = 2, 10%). Organized thrombus or a combination of pannus and thrombus was reported in 5 (71%) episodes of failed thrombolytic therapy, while was noted in 4 (36.3%) episodes not receiving fibrinolytic (p = 0.03). Complete hemodynamic and clinical success was obtained in eighteen (90%). One death (5%) occurred after surgery in a 49-year-old man with a history of redo TV replacement and treated with a strategy of slow (6 hours), single infusion of low-dose alteplase (50 mg) before surgery, and one patient (5%) was complicated with non-hemorrhagic stroke following operation. The means of hospital stay among patients underwent surgical procedure as a first step and those after failed thrombolytic were 23.2 ± 19 and 24.5 ± 8.2 days, respectively.