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Mechanical valve thrombosis is a rare but disastrous complication after mechanical valve replacement. The preferred treatment for left-sided mechanical valve thrombosis is still under investigation. Our aim was to compare and evaluate the effectiveness and safety of surgical management and thrombolytic therapy (TT) for left-sided mechanical valve thrombosis.
Relevant studies published before Feb. 2016 were collected in several databases and analyzed with Comprehensive Meta-Analysis software version 2.0. Outcomes of interest were death, major thromboembolic events, major bleeding events, and success rate.
Forty-nine studies including 2249 patients were included. Mortality for surgery was 17.56% (95% CI 15.38%-19.97%), which was significantly higher than the mortality rate of TT (6.22%, 95% CI 4.89%-7.87%, P<0.0001). The success rates were similar between the two groups. No significant difference was found in the incidence of the combined adverse event (death + major thromboembolic event + major bleeding event) between the surgery group (18.56%, 95% CI 16.32%- 21.02%) and TT group (16.38%, 95% CI 14.26-18.74, P=0.196).
In the absence of randomized controlled trials, this meta-analysis including 2249 patients showed that thrombolytic therapy may be a preferred approach over surgery in the treatment of left-sided mechanical valve thrombosis.