SURGICAL-MANAGEMENT OF PROSTHETIC VALVE OBSTRUCTION WITH THE SORIN TILTING DISC PROSTHESIS

Background and aims of the study: Thrombotic occlusion is a potentiall y fatal complication of heart valve replacement surgery. The purpose o f this report is to present our experience in the treatment of this gr oup of patients, with emphasis on valve debridement as an effective su rgical cure. Material and methods: Of 299 operative survivors undergoi ng valve replacement with Sorin Carbocast tilting disc prostheses at o ur institution 270 could be followed up: 18 of them (6.7%) developed t hrombosis within 26 months. All thrombotic blocks occurred in the mitr al position. Anticoagulation was sub-therapeutic in 13 patients. Clini cally, the patients presented with dyspnea, congestive cardiac failure , acute pulmonary edema or chest pain. Prosthetic valve closure sounds were absent or muffled in all patients and new murmurs developed in t wo. The average duration of symptoms was 3.0 days (range eight hours t o 15 days). Diagnosis was made on physical examination alone, and echo cardiographic confirmation was possible in 11 patients. Ten underwent emergency surgery, all by valve debridement with retention of the pros thesis. Results: Of the operated patients, eight survived with restora tion of prosthetic valve function, Complications including hypoxic enc ephalopathy and acute renal failure occurred in two patients (20%). On e death occurred 13 months later due to renal failure. At a follow up of 18 to 32 months (mean 21.3 months), seven patients are alive and we ll, and NYHA functional class I or II. One patient developed a recurre nt prosthetic valve thrombotic occlusion, and underwent successful sur gical debridement for a second time. Thrombolysis was attempted in two cases with early success, but recurrent prosthetic valve thrombosis o ccurred. Conclusions:The incidence of PVT was 6.7% in 270 patients wit h Sorin tilting disc valves implanted and followed up for 26 months. T hough thrombolysis is initially successful, recurrent valve thrombosis is a risk. Emergency surgical treatment allowed 70% mid term survival after valve debridement alone, Adequate anticoagulation and regular m edical follow up postoperatively need to be strongly emphasized.