Mitral repair: an extending application in mitral valve surgery

Mitral valve surgery remains to be one of the commonest encounters in cardiac surgery practice in Egypt, the concept of valve repair versus replacement is growing and more surgeons prefer the former technique due to the age incidence and presentation. The majority of the patients in our study were adolescents and young adults [age 9- 63 years - mean 24 years]. Female gender was more prevalent and almost 74% of which were in the childbearing period. Isolated mitral valve surgery was 63% of cases; the rest was combined coronary surgery and other valve surgery 36.2% and one case valve surgery with CABG 0.8%. Our results showed that group A which underwent mitral valve repair [58 case] had a slightly better success rate significantly lower incidence of postoperative complications and mortality rate and lead a more physiologic healthy almost normal life during postoperative follow up. In the group with mitral replacement the adoption of preserving the posterior cusp and its subvalvular apparatus proved to be much superior than total excision of both cusps, our immediate and long term follow up proved better results in this subgroup. In conclusion mitral valve repair if properly done give superior results and life style than patients who needed mitral valve replacement and if this was inevitable partial preservation of mitral valve improves both short and long term results

Late results of valve replacement experience of the National Heart Institute Imbaba Cairo Egypt

A randomized retrospective study of 5 years follow up of all valve replacement of a series inserted in The National Heart Institute has been done to evaluate the late results of such a procedure. Between January 1st 1984 and December 31st 1988 a total number of 958 valve prosthesis were inserted in 685 patients, The immediate post-operative mortality is 46 patients [6,71%] of different causes. This work concerns the long term results of the 639 patients discharged from hospital after the post-operative period. A follow up of these patients between 32 months and 81 months [mean period of 47,23 months] showed that 496 pts are living [survival rate: 77,62%]. None of the patients of this series were lost to follow up. Out of the 496 pts, 322 pts have improved post-operatively the quality of their life; 82 pts are living postoperatively in stage II NYHA and 92 in stage III NYHA living on digitalo-diuretic therapy and vasodilators. The pre-operative state of the heart, the quality of myocardial protection which were standardized in all patients of the series and the wall stress of LV played an important role in post-operative results. Out of the 143 dead patients, 82[57,34%] died of anticoagulation problems, 23 pts [16,08%]from endocarditis, 6[4,19%] from aseptic detachment of prosthesis; 10 [6,99%] valve prosthesis dysfunction; 22 [15,38%] the cause of death is unknown. No haemolysis occurred as a late complication. Apart from the Wessex and the Ionescu valve prosthesis, there was no significant difference between the different prostheses used in this series. From the above results one may conclude, that valve replacement is not the ideal treatment. All efforts should be directed to preserve the patients native valve as long as possible. anticoagulation problems and endocarditis are the main complications of valve replacement in Egypt. Well selected patients for valve replacement improve considerably the post-operative functional results