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Article Type

Original Study

Abstract

Objective Prosthetic mitral valve dysfunction remains a devastating complication in heart surgery. This study aims to assess the risk factors and the technical approaches to reach the best way to deal with and improve the outcome in these patients. Patients and methods Between January 2002 and March 2005, 60 patients underwent emergency reoperation for prosthetic mitral valve dysfunction, where 36 (60%) patients were in New York Heart Association class III, and 24 (40%) patients were in New York Heart Association class IV. There were 33 (55%) male and 27 (45%) female patients. The mean age at operation was 32.4 ± 6.3 years. Nine (15%) patients presented with fever. Hemodynamic status was unstable in 18 (30%) patients. Surgery has been carried out through repeat sternotomy or right anterolateral thoracotomy. Results The 30-day mortality rate was 12 (20%) patients. Analysis of preoperative, intraoperative, and postoperative factors revealed that significant predictors of early mortality were the surgical approach, time until surgical intervention, and depression of left ventricular function. The cause of prosthetic mitral valve malfunction was valve thrombosis in 39 (65%) patients, pannus formation in nine (15%) patients, paravalvular leakage in three (5%) patients, and prosthetic valve endocarditis (PVE) in nine (15%) patients. Right anterolateral thoracotomy (24.3 ± 8.5 min) proved to be faster than median sternotomy (63.1 ± 63 min) from skin incision to on bypass with a significant reduction of intraoperative complications and postoperative wound infections. Conclusion Hospital mortality can be reduced in patients with prosthetic mitral valve dysfunction if the surgery is carried out before cardiac dysfunction develops, with excellent results. Right anterolateral thoracotomy is feasible and safe for selected patients and should be considered whenever repeat median sternotomy could prove to be hazardous especially in the prominent right ventricle and pulmonary hypertension.

Keywords

Complication, risk factor, thoracotomy

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