46
Table 32. Fibrinolysis Versus Surgery for Prosthetic Valve
Thrombosis
Favor Surgery Favor Fibrinolysis
Readily available surgical expertise No surgical expertise available
Low surgical risk High surgical risk
Contraindication to fibrinolysis No contraindication to fibrinolysis
Recurrent valve thrombosis First-time episode of valve thrombosis
NYHA class IV NYHA class I–III
Large clot (>0.8 cm
2
) Small clot (≤0.8 cm
2
)
Le atrial thrombus No le atrial thrombus
Concomitant coronary artery disease
(CAD) in need of revascularization
No or mild CAD
Other valve disease No other valve disease
Possible pannus rombus visualized
Patient choice Patient choice
Table 33. Prosthetic Valve Regurgitation
Recommendations COR LOE
Surgery is recommended for operable patients with
mechanical heart valves with intractable hemolysis or HF due
to severe prosthetic or paraprosthetic regurgitation.
I B
Surgery is reasonable for asymptomatic patients with severe
bioprosthetic regurgitation if operative risk is acceptable.
(Modified recommendation for 2017)
IIa C-LD
Percutaneous repair of para-valvular regurgitation is
reasonable in patients with prosthetic heart valves and
intractable hemolysis or NYHA class III/IV HF who are
at high risk for surgery and have anatomic features suitable
for catheter-based therapy when performed in centers with
expertise in the procedure.
IIa B
For severely symptomatic patients with bioprosthetic aortic
valve regurgitation judged by the heart team to be at high or
prohibitive risk for surgical therapy, in whom improvement
in hemodynamics is anticipated, a transcatheter valve-in-valve
procedure is reasonable. (New recommendation for 2017)
IIa B-NR
Prosthetic Valves
