Urgent Surgery Versus Fibrinolytic Therapy in Left-Sided Prosthetic Valve Thrombosis: Insights from a Groundbreaking Randomized Trial

Highlight

• This landmark randomized controlled trial (RCT) is the first to directly compare urgent surgery versus fibrinolytic therapy (FT) using low-dose, slow-infusion tissue plasminogen activator (t-PA) for symptomatic left-sided prosthetic valve thrombosis (PVT).
• The study found no significant difference in complete clinical response between urgent surgery and fibrinolysis but reported significantly higher composite adverse events — particularly death — associated with surgery.
• Fibrinolytic therapy, while safer, was associated with a notable proportion of residual valve dysfunction post-treatment.

Study Background and Disease Burden