Thrombolytic Therapy Versus Surgery for Obstructive Prosthetic Valve Thrombosis: A Randomized Multicenter Study
Overview
- Phase
- Not Applicable
- Intervention
- Surgery
- Conditions
- Obstructive Thrombus
- Sponsor
- Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital
- Enrollment
- 100
- Locations
- 1
- Primary Endpoint
- Non-fatal complications for thrombolytic therapy
- Last Updated
- 11 years ago
Overview
Brief Summary
Prosthetic heart valve thrombosis is a serious complication with high mortality and morbidity The best treatment of PVT is controversial, although surgery and thrombolysis options have been available. In this randomized and multicenter study, the investigators compared thrombolytic therapy versus surgery for the treatment of patients with obstructive prosthetic valve thrombosis.
Detailed Description
Two different randomization group have been defined and patients with obstructive prosthetic valve thrombosis are included in each group randomly. In the first arm, thrombolytic therapy (TT) is performed to the patients with obstructive prosthetic valve thrombosis. The TT regimen depends on the functional status of the patient. In patients with NYHA class III-IV dyspnea low dose, relatively faster TT regimen (25 mg tPA/6 hours) is performed. In patients with NYHA class I-II dyspnea TT with low dose and ultra slow infusion of tPA (25 mg tPA/25 hours) is performed. During TT, patients are followed up with transesophageal echocardiography in every 24 hours. In the second arm, redo valve surgery is performed for obstructive valve thrombosis. This multicenter study is conducted in Cardiology and Cardiovascular Surgery Departments of Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey, Siyami Ersek Heart Training and Research Hospital, Istanbul, Turkey, Ankara Heart Training and Research Hospital, Ankara, Turkey, İzmir Atatürk Heart Training and Research Hospital, İzmir, Turkey, Erzurum Atatürk University Faculty of Medicine, Erzurum, Turkey, Diyarbakır Dicle University Faculty of Medicine, Diyarbakır, Turkey and Kars Kafkas University Faculty of Medicine, Kars, Turkey. Informed consent is taken from all patients.
Investigators
MEHMET OZKAN
Professor
Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital
Eligibility Criteria
Inclusion Criteria
- •Obstructive prosthetic valve thrombosis
Exclusion Criteria
- •Non-obstructive prosthetic valve thrombosis
Arms & Interventions
Surgery
In the second arm, redo valve surgery is performed for obstructive valve thrombosis. Intraoperative and postoperative results are recorded
Intervention: Surgery
Thrombolytic therapy
In the first arm, thrombolytic therapy (TT) is performed to the patients with obstructive prosthetic valve thrombosis. The TT regimen depends on the functional status of the patient. In patients with NYHA class III-IV dyspnea low dose, relatively faster TT regimen (25 mg tPA/6 hours) is performed. In patients with NYHA class I-II dyspnea TT with low dose and ultra-slow infusion of tPA (25 mg tPA/25 hours) is performed. During TT, patients are followed up with transesophageal echocardiography in every 24 hours.
Intervention: Thrombolytic Therapy
Outcomes
Primary Outcomes
Non-fatal complications for thrombolytic therapy
Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 3 weeks
Nonfatal major complication: Ischemic stroke, intracranial hemorrhage, embolism (coronary or peripheral), bleeding requiring transfusion. Nonfatal minor complication: Bleeding without need for transfusion, TIA.
Thrombolytic success
Time Frame: Up to 10 days
In the absence of fatal or nonfatal major complications; Obstructive thrombus: Doppler documentation of the resolution of increased gradient and decreased valve area. Clinical improvement in symptoms. Reduction by ≥75% in major diameter or area of the thrombus. Complete success was defined when all 3 criteria were met and partial success was defined as less than 3 Nonobstrucive thrombus: Complete success: ≥75% reduction in thrombus area. Partial success: 50%-75% reduction in thrombus area
Successful Surgery
Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 3 weeks; and postoperative 3 months
Successful redo valve surgery in the absence of fatal and non fatal major complications.
Complications for surgery
Time Frame: Participants will be followed for the duration of hospital stay an expected average of 3 weeks; and postoperative 3 month
Non fatal major complications: Ischemic stroke, intracranial hemorrhage, embolism (coronary or peripheral), bleeding requiring transfusion, pericardial tamponade, sepsis, pacemaker requirement, mediastinitis, wound infections, acute renal failure Minor complications: bleeding requiring transfusion, plevral effusion, pericardial effusion without tamponade
In hospital mortality
Time Frame: Participants will be followed for the duration of hospital stay, an expected average of 3 weeks
All cause in-hospital mortality.