Clinical outcomes of isolated redo mitral valve replacement in patients with mitral prosthetic heart valve dysfunction
1University Of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training And Research Hospital, Cardiology, İstanbul, Turkey
2University Of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training And Research Hospital, Cardiovascular Surgery, İstanbul, Turkey
3İzmir Katip Çelebi University, Atatürk Training And Reseach Hospital, Cardiology, İstanbul, Turkey
Keywords: echocardiography, prosthetic valve, valve surgery
Objectives: Redo mitral valve replacement (redo-MVR) represents a clinical challenge due to a higher rates of peri-operative morbidity and mortality.
Patients and Methods: This retrospective study enrolled a total of 103 patients who underwent isolated redo-MVR due to prosthetic valve dysfunction. Patients who had an isolated bypass, low echocardiographic quality, history of repeated re-replacements (more than twice), paravalvular leak repair without preoperative and intraoperative transesophageal echocardiography examination, isolated congenital surgery or isolated open-heart surgical intervention (of any type) without a valve procedure at their first or later operations were excluded. The primary endpoint of the study was in-hospital death. Secondary endpoint included individual morbidity.
Results: A total of 103 patients (mean age: 50.7 13.4 years; male: 58) who underwent isolated redo-MVR were enrolled in this study. The most common complaint of the patients at admission was obstruction or heart failure-related symptoms (80.6%) and the primary indication for redo-MVR was prosthetic valve thrombosis in 58 patients (56.3%). In-hospital mortality was 12.6% (13 patients). The post-operative complications included major bleeding (n=11) post-operative infection (sepsis, mediastinitis, pneumonia, wound infection, n=15), low cardiac output syndrome (n=10), acute kidney injury (n=17), pericardial effusion with tamponade (n=10), pleural effusion requiring hospitalization and drainage (n=18), ischemic stroke (n=4), fatal ventricular arrhythmia (n=1), peripheral embolism (n=1), moderate to severe paravalvular leak (n=5). There was not any catastrophic heart laceration.
Conclusion: In-hospital mortality and complications of the isolated redo-MVR in our center are acceptable. With a well-defined protocol and appropriate patient selection, mortality in emergencies cases may be reduced.