¿Debe operarse la trombosis protésica mitral grande no oclusiva?

Large prosthetic thrombosis, thrombus >5 mm or >0.8 cm2, is associated with high morbidity and mortality. We present a series of 9 cases of large non-obstructive prosthetic thrombosis in the mitral position. The initial treatment was anticoagulation therapy in 4 patients, fibrinolysis in 3 and surgery in 2. Surgery was required as the definitive treatment in 8 of the 9 patients (89%). The mean time to surgery was 6.7 days from hospital admission and 70.2 days for patients who were readmitted, with a mean increase in the Euroscore of 9.05% and a surgery success rate of 63%. Total early mortality was 33%, reaching 55% during follow-up. Surgery is probably the most effective treatment for large prosthetic mitral valve thrombosis, and delay in therapeutic decision-making implies an increase in mortality. Optimal anticoagulant and fibrinolytic therapy are often not definitive and not without complications.