Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis: The Multicenter HATTUSHA Study.
In: Journal of the American College of Cardiology (JACC), Jg. 79 (2022-03-15), Heft 10, S. 977-989
Online
academicJournal
Zugriff:
Background: Prosthetic valve thrombosis (PVT) is one of the life-threatening complications of prosthetic heart valve replacement. Due to the lack of randomized controlled trials, the optimal treatment of PVT remains controversial between thrombolytic therapy (TT) and surgery. Objectives: This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT. Methods: A total of 158 obstructive PVT patients (women: 103 [65.2%]; median age 49 years [IQR: 39-60 years]) were enrolled in this multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery. Results: The initial management strategy was TT in 83 (52.5%) patients and surgery in 75 (47.5%) cases. The success rate of TT was 90.4% with a median t-PA dose of 59 mg (IQR: 37.5-100 mg). The incidences of outcomes in surgery and TT groups were as follows: minor complications (29 [38.7%] and 7 [8.4%], respectively), major complications (31 [41.3%] and 5 [6%], respectively), and the 3-month mortality rate (14 [18.7%] and 2 [2.4%], respectively). Conclusions: Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT. [ABSTRACT FROM AUTHOR]
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Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis: The Multicenter HATTUSHA Study.
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Autor/in / Beteiligte Person: | Özkan, Mehmet ; Gündüz, Sabahattin ; Güner, Ahmet ; Kalçık, Macit ; Gürsoy, Mustafa Ozan ; Uygur, Begüm ; Keleş, Nurşen ; Kaya, Hasan ; Kılıçgedik, Alev ; Bayam, Emrah ; Kalkan, Semih ; Astarcıoğlu, Mehmet Ali ; Karakoyun, Süleyman ; Yesin, Mahmut ; İnan, Duygu ; Fedakar, Ali ; Sarıkaya, Sabit ; Aksüt, Mehmet ; Onan, Burak ; Koçoğulları, Cevdet Uğur |
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Zeitschrift: | Journal of the American College of Cardiology (JACC), Jg. 79 (2022-03-15), Heft 10, S. 977-989 |
Veröffentlichung: | 2022 |
Medientyp: | academicJournal |
ISSN: | 0735-1097 (print) |
DOI: | 10.1016/j.jacc.2021.12.027 |
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