BACKGROUND: Obstructive prosthetic valve thrombosis is a life-threatening complication associated with high morbidity and mortality. Evaluation of outcomes of surgical management and identification of the perioperative variables associated with poor prognosis are necessary to provide appropriate interventions. RESULTS: We conducted a retrospective analysis of 39 patients who underwent redo surgery for obstructive prosthetic valve at the Madinah Cardiac Center, Saudi Arabia. Between January 2017 to October 2023 Preoperative, intraoperative, and postoperative factors that influenced the outcome were analyzed. The nature of the obstructed valve was commonly mechanical (32/39, 82.1%) located in the mitral position (30/39, 76.9%) which occurred due to thrombosis, and the size of the thrombus was more than 1 cm in 27 (69.2%) patients. High percentage (25/39, 64.1%) of the patients had a suboptimal INR (less than 2). The major postoperative complications were respiratory failure (6/39, 15.4%) and dysrhythmias (20/39, 51.3%). The 30-day postoperative mortality was 7.7% (3/39). Patients who underwent surgery after failed thrombolysis had significantly higher mortality than those who underwent direct surgery (p = 0.018). CONCLUSION: Prosthetic valve thrombosis is primarily associated with suboptimal anticoagulant therapy and can occur years after valve replacement surgery. The prognosis for redo valve replacement is favorable with a 30-day operative mortality rate of 7.7%. For patients with prosthetic valve thrombosis, direct surgical intervention without prior fibrinolysis may be safe and effective for patients with prosthetic valve thrombosis.