{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:07:01Z","timestamp":1791446821558,"version":"4.3.3"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The optimal strategy in prosthetic heart valve thrombosis (PVT) remains controversial, with no randomized trials and conflicting observational data. We performed a systematic review and meta\u2010analysis of evidence comparing systemic thrombolysis and cardiac surgery in PVT.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We searched PubMed, the Cochrane Library, and Embase for studies on treatment strategies in patients with left\u2010sided PVT since 2000. The primary outcome was death, and the secondary outcomes were major bleeding and thromboembolism during follow\u2010up (International Prospective Register of Systematic Reviews No. CRD42022384092). We identified 2298 studies, of which 16 were included, comprising 1389 patients with PVT (mean age, 50.4\u00b19.3\u2009years; 60.0% women). Among them, 67.2% were New York Heart Association stage III\/IV at admission. Overall, 48.1% were treated with systemic thrombolysis and 51.9% with cardiac surgery. The mortality rate was 10.8% in the thrombolysis group and 15.3% in the surgery group. The pooled risk difference for death with systemic thrombolysis was 1.13 (exact CI, 0.74\u20131.79;\n              <jats:italic>\u03b6<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\n              =0.89;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) versus cardiac surgery. Rates of both transient ischemic attack and non\u2013central nervous system embolism were higher in the thrombolysis group (\n              <jats:italic>P<\/jats:italic>\n              =0.002 and\n              <jats:italic>P<\/jats:italic>\n              =0.02, respectively). Treatment success, major bleeding, and stroke were similar between groups. Sensitivity analysis including studies that used low\u2010dose or slow\u2010infusion thrombolysis showed that the mortality rate was lower, and treatment success was higher, in patients referred to systemic thrombolysis, with similar rates of other secondary outcomes.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">There is evidence to suggest that thrombolysis might be the preferred option for the management of PVT without cardiogenic shock, pending future randomized controlled trials or larger observational studies.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.035143","type":"journal-article","created":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T09:29:02Z","timestamp":1726651742000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Surgery Versus Thrombolytic Therapy for the Management of Left\u2010Sided Prosthetic Valve Thrombosis Without Hemodynamic Compromise: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8358-515X","authenticated-orcid":false,"given":"Romain","family":"Chopard","sequence":"first","affiliation":[{"name":"Department of Cardiology University Hospital Besan\u00e7on France"},{"name":"SINERGIES University of Franche\u2010Comt\u00e9 Besan\u00e7on France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4695-3077","authenticated-orcid":false,"given":"Charles","family":"Vidoni","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital Besan\u00e7on France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Besutti","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital Besan\u00e7on 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