1- Introduction
Tricuspid valve (TV) prosthesis is associated with an 11.7 times higher risk of thrombosis than other heart valves and it may occur in approximately 20% during the first postoperative year [1,2]. In non-randomized cohorts of thrombosed mechanical or biological TV prostheses, fibrinolysis has been successful to normalize hemodynamics; therefore, AHA/ACC and ESC/EACTS recommend that fibrinolysis is reasonable in patients with TV thrombosis [3,4]. Thrombolytic therapy has been successfully used as a first management in obstructive right-sided valvular thrombosis [1,3]. Moreover, several regimens of thrombolytic agents, including high dose recombinant tissue plasminogen activators or streptokinase, a low dose-slow and even ultraslow infusion of tissue plasminogen activators, and direct intra-atrial infusion of thrombolytic has been attempted [5-8]. However, there is limited data on optimum choice of treatment.
As the mechanical TV replacement is rarely performed, there is lack of data about the outcomes in large series, so the recommendations of guidelines are based on small case series and case reports. In a review study, Huang et al. [9] reported the clinical outcomes of forty-eight patients with mechanical TV thrombosis in the literatures from 1995 to 2013 year that underwent thrombolytic therapy and/or surgery. They found that complete success with thrombolytic therapy developed in 88% with no serious complications; however, the late outcomes of patients were not completely described.
In this single-center study, we sought to conduct a comprehensive retrospective study to evaluate the management and the early outcomes of patients with mechanical TV thrombosis, and also to provide long-term follow-up.