Outcomes of surgical treatment of obstructive prosthetic aortic valve thrombosis

Aim. Comparative analysis of the outcomes of surgical treatment of obstructive prosthetic aortic valve thrombosis (OPVT).

Material and methods. This retrospective analysis of medical records of patients diagnosed with OPVT was performed for the period from 2010 to 2023. In the postoperative period, 49 patients were diagnosed with OPVT and underwent resurgery. Storage and calculation of all data was performed in SPSS 26 (2019) and MS Excel, Word 2016. Data are expressed as mean values, standard deviations or medians. Univariate analysis was performed using Student’s t-test for parametric data. For nonparametric data, the KruskalWallis test was used. Survival analysis was performed using the Kaplan-Meier curves.

Results. Cardiopulmonary bypass and aortic cross-clamp durations were significantly lower than in patients with repeat grafting (84,5±65,1 min, 130,6±36,3 min, P<0,05 and 37,2±14,2 min, 93,7±23,1 min, P<0,05, respectively). Mean intensive care unit stay after thrombectomy was 2,68±1,6 days, while after resurgery — 6,8±6,4 days (P>0,05). In the early and late postoperative periods, no differences were found in the maximum and mean transaortic gradients in patients in both groups. Inhospital mortality was 14,3% (n=7). Operative mortality was 4,1% (n=2). Inhospital mortality was higher in the thrombectomy group, but the differences were not significant. Five-year survival after repeated AV replacement was 82%, and in the thrombectomy group — 70% taking into account inhospital mortality.

Conclusion. The results of prosthetic AV thrombectomy in the early and late periods are comparable with repeat AV replacement data. Thrombectomy is a faster and simpler surgical method for restoring the artificial heart valve function, compared with repeat replacement. The choice of surgical strategy should be based on the intraoperative valve assessment.

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