Thrombolytic therapy versus cardiac surgery for left-sided prosthetic heart valve thrombosis: A systematic review and meta-analysis.

Authors

Babak Bagheri, Sahar Eskandari, Saeid Soltani, Rozita Jalalian, Jamshid Yazdani Charati, Masoud Moradi, Mohammadreza Iranian

Published in

American heart journal plus : cardiology research and practice. Volume 69. Pages 100849. Epub Jul 29, 2026.

Abstract

The optimal treatment of prosthetic heart valve thrombosis (PVT) remains vigorously debated in international guidelines. The present study was designed to compare the efficacy and safety of thrombolytic therapy and surgery in left-sided PVT, incorporating recent data to inform clinical decision-making.
This study is a systematic review with meta-analysis. We searched PubMed, Scopus, and Embase up to Jun 30, 2025. Eligible studies were those reporting treatment strategies and outcomes of patients with left-sided PVT. The primary outcome was treatment success (survival for surgery; complete or partial improvement of valve function and hemodynamic success not requiring surgery after thrombolysis).
114 studies were included, representing 6514 patients with 6744 PVT episodes. The success rate in both treatment groups was the same: 83.9% (95% CI: 82.2-85.4; I² = 19.8%) for thrombolysis versus 85.1% (95% CI: 83.3-86.7; I² = 27%) for surgery (P-value = 0.607). The mortality rate was lower with thrombolysis (8.5%; 95% CI: 7.5-9.8; I² = 0%) than surgery (15%; 95% CI: 13.4-16.8; I² = 26.3%) (P-value = 0.001). Other secondary outcomes showed no significant differences. In the slow/very slow thrombolytic infusion subgroup analysis, the success rate was 91.4% (95% CI: 87-94; I² = 44.9%) and the mortality was 2.1% (95% CI: 1.2-3.3; I² = 0%).
This systematic review suggests that fibrinolytics are a reasonable option alongside surgery for left-sided PVT, with similar success rates and lower mortality. However, due to observational evidence, results should be interpreted cautiously and randomized controlled trials (RCTs) are needed.

PMID:
42571223
Bibliographic data and abstract were imported from PubMed on 09 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.