3-5 Recurrent thrombosis
There were 24 episodes of recurrent mechanical TV dysfunction due to thrombosis. Of these episodes, 10 occurred following thrombolytic therapy, 8 after anticoagulant intensification, and 6 following surgical procedure. There was significantly shorter mean of interval between recurrent events and previous thrombolytic treatment than surgery (13.2 ± 14.1, 95% confidence interval [CI] 5.8-20.5 vs. 66 ± 36, 95% CI 36.8-95.1 months, p <0.001), in) Table 3( . With respect to the choice of treatment and response to therapy, in recurrent episodes following previous thrombolytic therapy, five (50%) cases received fibrinolytic again as the treatment option; of which three (60%) were successful and two (40%) cases required subsequent surgery due to failed thrombolytic treatment. In recurrent episodes following previous redo TV replacement, five (83.3%) cases received successful fibrinolytic therapy. Although, five (62%) episodes with partial response in our study were a recurrent episode, there was no statistically significant association regarding treatment response in recurrence and non-recurrence episodes (the thrombolytic success rate was 66.7% in episodes which were not a recurrence).
Sixteen (38%) patients presented with at least one episode of recurrent thrombosis during the median follow-up time of 31.1 months (0.53-155.9). Kaplan-Meier estimation for freedom from the first recurrence of thrombosis revealed that at the end of first 2 years irrespective of the treatment strategy, 84% of patients were free of recurrent thrombosis; however, this declined to 61% and 21% at the end of 4 and 10 years, respectively. The median time for the first recurrence in patients was 85.5 months (95% CI 41.8-129.2), (Fig. 2).