Surgical Thrombectomy and Pannus Removal in Prosthetic Heart Valve Obstruction: A Case-Series of a Single-Center Experience Publisher



Rahmanian M ; Moghadam A S ; Kalhor A ; Shahriyari S ; Larti F ; Badkoubeh R S ; Salehi M
Source: Journal of Cardiac Surgery Published:2026

Abstract

Background: Prosthetic heart valve obstruction (PHVO) due to thrombosis or pannus formation is a significant complication following mechanical valve replacement. Thrombectomy and pannus removal offer a surgical alternative to valve replacement for PHVO. This study aims to evaluate the clinical outcomes of patients undergoing these procedures. Methods: This single-center case series study included 143 patients with a history of mechanical bileaflet prosthetic heart valve replacements who presented with PHVO and underwent surgical pannus removal or thrombectomy between 2014 and 2022. Patients with infective endocarditis or paravalvular leakage were excluded from the study. The preoperative assessment included echocardiography (transthoracic and/or transesophageal), fluoroscopy, and a laboratory workup. Outcomes, including in-hospital mortality and long-term survival, were recorded. Results: Thrombectomy was performed in the aortic position in 43 patients (30%), mitral position in 65 (45.4%), and tricuspid position in 7 (4.8%), with 28 patients (19.5%) undergoing simultaneous cleansing of two valves. The median postoperative hospital stay was nine days, and the in-hospital mortality rate was 9.8%. After a mean follow-up of 4.3 years, a 28.7% overall mortality rate, with half of these deaths attributed to cardiovascular causes, was detected. Four patients experienced recurrent valve thrombosis, and two underwent a second valve cleansing surgery. Conclusions: Valve thrombectomy and pannus removal were associated with favorable postoperative outcomes, though in-hospital mortality remained at 9.8%. This study highlights the need for randomized clinical trials to compare surgical options and optimize treatment for PHVO. Copyright © 2026 Mehrzad Rahmanian et al. Journal of Cardiac Surgery published by John Wiley & Sons Ltd.