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Influence of Valve Position on Outcomes of Surgery Versus Fibrinolysis in Prosthetic Valve Thrombosis: A Meta-Analysis and Meta-Regression
Session:
Sessão de Posters 51 - Circulação pulmonar, pericárdio e cuidados agudos
Speaker:
Ana Marta C. Pinto
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.6 Acute Cardiac Care – Other
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Ana Marta C. Pinto; Emídio Mata; Bernardo Resende; Margarida Castro; João Gameiro; Sílvia Ribeiro; Filipa Cordeiro; Gonçalo Ferraz-Costa; Lino Gonçalves; António Lourenço
Abstract
<p>Background: Obstructive prosthetic valve thrombosis (PVT) is a rare but life-threatening complication. While urgent surgery has traditionally been the standard of care, fibrinolytic therapy has emergedas a less invasive alternative in selected patients. The influence of the affected valve position on treatment outcomes remains unclear. </p> <p>Objective: To compare surgery and fibrinolysis for prosthetic valve thrombosis using meta-analysis and meta-regression, examining valve position as a potential modifier of treatment effect. </p> <p>Methods: A systematic search of five databases identified studies comparing fibrinolysis with surgery for prosthetic valve thrombosis. Random-effects meta-analyses were conducted to estimatepooled risk ratios (RRs) with 95% confidence intervals, and mixed-effects meta-regression was used to evaluate the influence of valve position on in-hospital mortality, complete valve restoration(without associated death), and recurrence. </p> <p>Results: Thirteen studies (12 observational, 1 randomized control trial; 586 fibrinolysis, 714 surgery) were included. The distribution of affected valves varied across studies: aortic (A) 8.5–55.0%, mitral(M) 54.8–93.7%, tricuspid (T) 1.5–20.0%, and combined valve involvement (A–M or M–T) 0.7–10.6%. </p> <p>Meta-regression showed no significant moderating effect of valve position on any outcome. For in-hospital mortality, the baseline risk ratio (RR) for a fully non-aortic cohort was 1.01 [0.32–3.17], andeach 10% increase in aortic valve involvement was associated with a non-significant 14% relative decrease in RR (0.86 [0.60–1.24] QM(1)=0.64, p=0.42). </p> <p>For complete valve restoration, the baseline RR for a fully non-aortic cohort was 2.67 [1.10–6.48], indicating a significant advantage for surgery over fibrinolysis, while each 10% increase in aortic valveprevalence corresponded to a non-significant 10% decrease in RR (0.90 [0.66–1.21] QM(1)=0.53, p=0.47). For recurrence, the baseline RR for a fully non-aortic cohort was 2.10 [0.57–7.68], with each10% increase in aortic valve prevalence associated with a non-significant 7% relative increase in RR (1.07 [0.66–1.74] QM(1)=0.08, p=0.78). </p> <p>Discussion: Surgical treatment remained associated with higher rates of complete valve restoration, while mortality and recurrence were similar between strategies, irrespective of valve location. Thesefindings suggest that treatment choice should primarily consider patient clinical status and procedural risk rather than valve position alone. </p>
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