Author + information
- Kashish Goel,
- William Miranda,
- Abdallah El Sabbagh and
- Rick Nishimura
Background: Prolonged administration of low dose thrombolysis has been shown to be an effective treatment of left-sided mechanical valve thrombosis (VT). Although current guidelines also recommend thrombolysis in right-sided mechanical VT, there is paucity of data in this subset of patients.
Methods: We included all patients receiving thrombolysis for tricuspid or pulmonary mechanical VT between Jan 2006 and Dec 2015. Medical records were assessed for dosing regimens, outcomes and follow-up. VT was confirmed by echocardiography and/or fluoroscopy. Complete success was defined as resolution of symptoms, normal leaflet motion and normal valve hemodynamics.
Results: We identified 13 patients who received thrombolysis (9 tricuspid, 3 pulmonary and 1 both). The primary reason for valve replacement was congenital (n=8), pacemaker-related (n=2), radiation (n=1), rheumatic (n=1) or myopathic (n=1) heart disease. Mean age was 41 ± 15 years and 76 % were females. Three-fourths of the patients presented with NYHA class III symptoms. Three patients were asymptomatic and were found to have VT on routine evaluation. Median time from valve replacement to VT was 2.4 years (IQR 0.7-5.6). Alteplase was used in all patients; dosing regimens varied over the years from high dose bolus to low dose bolus followed by 90 mg over 2 hours to low dose non-bolus prolonged administration. Most patients received more than 1 dose of Alteplase. Six patients had complete success (46%); 5 patients (38%) had partial success and two patients had no improvement. Among the six patients with complete success, 50% had recurrence of valve thrombosis. Median time to surgery (n=4) or death (n=4) from the date of thrombolysis was 3.6 years (IQR 0.66 – 6.9). One-year survival free of surgery or death was 65%.
Conclusions: This is the largest study to-date in adult patients with right-sided mechanical VT undergoing thrombolysis in United States. Thrombolysis had complete or partial success in majority of the patients, however the recurrent thrombosis and mortality associated with repeat valve surgery is high. Future studies should systematically evaluate the impact of low dose and prolonged infusion of thrombolysis in right-sided VT.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 4:15 p.m.-4:25 p.m.
Session Title: Prosthetic Valve Thrombosis: TAVR, Bio, Mech… Now What?!
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 1260M-07
- 2017 American College of Cardiology Foundation