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Managing mechanical heart valve thrombosis (MHVT) in pregnant women remains challenging. We aim to evaluate the effectiveness and safety of surgery or thrombolysis for MHVT mothers and their fetuses.
Relevant studies published before March 2017 were collected in several databases and analyzed with SPSS 22.0. We searched studies with at least two patients treated with surgery or thrombolysis.
Seventy four studies comprising 224 pregnancies (153 adopting surgery, 71 receiving thrombolysis) were included. Duration of cardiopulmonary bypass (CPB) time ≥120min is significantly related to the poor fetal outcome of surgery. For patients at gestational age ranging from 26w to 36w, the fetal wastage rate in the subgroup of caesarean delivery before cardiac surgery was significantly lower than the patients whose delivery was carried out after the surgery. Compared with streptokinase subgroup, the mortality rate in the tissue-type plasminogen activator (tPA) subgroup was significantly lower while the success rate was significantly higher. The fetal and maternal outcomes of thrombolysis were comparable to the subgroup of surgery whose NYHA grades were III/IV.
For MHVT pregnant patients with NYHA III-IV, the therapeutic effect of thrombolysis may be comparable to the surgery. The protocol of low-dose, slow infusion of tPA with repeated doses as needed may be the optimal regimen for these patients. If surgery was adopted, CPB management of pregnant women should be addressed to improve maternal and fetal outcomes. For MHVT patients at gestational age ranging from 26w to 36w, caesarean section before surgery may be advisable.