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.