Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 May 2;11(3):251-263.
doi: 10.1093/ehjcvp/pvaf005.

Valve thrombosis and antithrombotic therapy after bioprosthetic mitral valve replacement: a systematic review and meta-analysis

Mark J Zorman  1   2 , Jonathan Vibhishanan  1 , Katerina Dangas  1 , James Castle  1 , Ka Hou Christien Li  1 , Marco Coronelli  1 , Kate Eastwick-Jones  1 , Alexander Swan  1 , Nicky Johnson  1 , Anurag Choksey  1 , Helen Yan  1 , Sam G C Scott  1 , Matthew Henry  3 , Mark Philip Cassar  1 , Cara Barnes  1 , Joao Ferreira-Martins  1 , James Newton  1 , Sam Dawkins  1 , Mohamad Alkhouli  2 , Charanjit Rihal  2 , Mackram F Eleid  2 , Sorin V Pislaru  2 , Mayra E Guerrero  2 , Jose Ordonez-Mena  4 , Thomas J Cahill  1
Affiliations
Meta-Analysis

Valve thrombosis and antithrombotic therapy after bioprosthetic mitral valve replacement: a systematic review and meta-analysis

Mark J Zorman et al. Eur Heart J Cardiovasc Pharmacother. .

Abstract

Aims: Transcatheter mitral valve replacement (TMVR) has become a feasible alternative to surgical mitral valve replacement (SMVR) in selected patients at high surgical risk. The risk of valve thrombosis following SMVR and TMVR, and the optimal antithrombotic therapy following these procedures, remains uncertain. We aimed to compare the incidence of bioprosthetic mitral valve thrombosis (bMVT) after SMVR and TMVR, and the incidence of bMVT between patients on different antithrombotic regimens.

Methods and results: A literature search of Medline, Embase, and Cochrane Library was performed between January 2000 and August 2024. Random-effects models were used to derive pooled estimates of the incidence of bMVT in the absence of prior or active endocarditis and valve thrombosis. A total of 47 studies (6170 patients, total follow-up 9541.8 patient-years) were eligible for inclusion. The overall incidence of bMVT was 5.05 [95% confidence interval (CI) 3.18-8.01, I2 = 82%] per 100-patient-years. Subclinical bMVT was more common than clinically significant bMVT: incidence 19.11 vs. 7.91 per 100-patient-years, adjusted incidence rate ratio (aIRR) 4.62 (95% CI 1.39-15.36), P = 0.012. bMVT was numerically more common after TMVR than SMVR, but the comparison was not statistically significant: incidence 7.03 vs. 0.58 per 100-patient-years, aIRR 2.19 (95% CI 0.72-6.72), P = 0.170. Patients on vitamin-K antagonists (VKA) had a lower incidence of bMVT than patients on direct oral anticoagulants (DOAC; incidence 5.72 vs. 17.08, aIRR 0.31, 95% CI 0.13-0.73, P = 0.007).

Conclusions: bMVT is not uncommon, with numerically higher incidence in transcatheter compared to surgical valves, but the comparison was not statistically significant. VKAs are associated with a lower incidence of bMVT compared to DOACs.

Keywords: Surgical mitral valve replacement; Transcatheter mitral valve replacement; Valve thrombosis.

PubMed Disclaimer

Figures

Graphical Abstract
Graphical Abstract
Valve thrombosis and antithrombotic therapy after surgical and transcatheter mitral valve replacement: a systematic review and meta-analysis. Created with Biorender.com.
Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Forest plot of log incidence rate of bioprosthetic mitral valve thrombosis. Studies are presented in ascending order of follow-up (pys, patient-years). IR, incidence rate and 95% CI, 95% confidence intervals.
Figure 3
Figure 3
Forest plot of log incidence rate of subclinical versus clinical bMVT. The analysis only includes studies with reported CT follow-up after discharge. IR, incidence rate and 95% CI, 95% confidence intervals.
Figure 4
Figure 4
Forest plot of log incidence rate of bMVT after SMVR vs. TMVR. Studies are presented in ascending order of follow-up (patient-years). IR, incidence rate and 95% CI, 95% confidence intervals. The unadjusted comparison of SMVR and TMVR is statistically significant (P < 0.01), but the groups are comparable when adjusted for study size and follow-up time (Table 2).
Figure 5
Figure 5
Oral anticoagulation after bioprosthetic mitral valve replacement. (A) Forest plot of log incidence rate of bMVT in patients taking anticoagulation vs. patient without. (B) Forest plot of log incidence rate of bMVT in patients taking DOACs vs. VKAs. Studies are presented in ascending order of follow-up (patient-years). IR, incidence rate and 95% CI, 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Messika-Zeitoun D, Candolfi P, Vahanian A, Chan V, Burwash IG, Philippon J-F, Toussaint J-M, Verta P, Feldman TE, Iung B, Glineur D, Mesana T, Enriquez Sarano M. Dismal outcomes and high societal burden of mitral valve regurgitation in France in the recent era: a nationwide perspective. J Am Heart Assoc 2020;9:e016086. 10.1161/JAHA.120.016086 - DOI - PMC - PubMed
    1. Cahill TJ, Prothero A, Wilson J, Kennedy A, Brubert J, Masters M, Newton JD, Dawkins S, Enriquez-Sarano M, Prendergast BD, Myerson SG. Community prevalence, mechanisms and outcome of mitral or tricuspid regurgitation. Heart 2021;107:1003–1009. 10.1136/heartjnl-2020-318482 - DOI - PubMed
    1. Mirabel M, Iung B, Baron G, Messika-Zeitoun D, Detaint D, Vanoverschelde J-L, Butchart EG, Ravaud P, Vahanian A. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J 2007;28:1358–1365. 10.1093/eurheartj/ehm001 - DOI - PubMed
    1. Yoon S-H, Whisenant BK, Bleiziffer S, Delgado V, Dhoble A, Schofer N, Eschenbach L, Bansal E, Murdoch DJ, Ancona M, Schmidt T, Yzeiraj E, Vincent F, Niikura H, Kim W-K, Asami M, Unbehaun A, Hirji S, Fujita B, Silaschi M, Tang GHL, Kuwata S, Wong SC, Frangieh AH, Barker CM, Davies JE, Lauten A, Deuschl F, Nombela-Franco L, Rampat R, Nicz PFG, Masson J-B, Wijeysundera HC, Sievert H, Blackman DJ, Gutierrez-Ibanes E, Sugiyama D, Chakravarty T, Hildick-Smith D, De Brito FS, Jensen C, Jung C, Smalling RW, Arnold M, Redwood S, Kasel AM, Maisano F, Treede H, Ensminger SM, Kar S, Kaneko T, Pilgrim T, Sorajja P, Van Belle E, Prendergast BD, Bapat V, Modine T, Schofer J, Frerker C, Kempfert J, Attizzani GF, Latib A, Schaefer U, Webb JG, Bax JJ, Makkar RR. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. Eur Heart J 2019;40:441–451. 10.1093/EURHEARTJ/EHY590 - DOI - PubMed
    1. Guerrero ME, Eleid MF, Wang DD, Pursnani A, Kodali SK, George I, Palacios I, Russell H, Makkar RR, Kar S, Satler LF, Rajagopal V, Dangas G, Tang GHL, Mccabe JM, Whisenant BK, Fang K, Balan P, Smalling R, Kaptzan T, Lewis B, Douglas PS, Hahn RT, Thaden J, Oh JK, Leon M, O'neill W, Rihal C. 5-Year prospective evaluation of mitral valve-in-valve, valve-in-ring, and valve-in-MAC outcomes: MITRAL trial final results. JACC: Cardiovasc Interv 2023;16:2211–2227. 10.1016/J.JCIN.2023.06.041 - DOI - PubMed

MeSH terms

Substances