Results and risk factors of mitral valve reoperation

ABSTRACT

To assess the results and risk factors of mitral valve re-operations 50 patients were operated upon at El Hussein University Hospital during the period from January 1998 to June 2003. The patients are fully investigated. It was found that age, EF, ACT, CBP were independent variables of the survival of the patients. As regard the clinical improvement, 16 [32.0%] patients were in class II preoperatively; postoperatively there were 8 of them [16.0%] in class II and 8[16.0%] patients in class III, postoperatively. Nine patients were in class III, postoperatively 8 of them [16.0%] were in class I and 1 [2.0%] patient was in class II. Eight patients were in class IV, postoperatively, 4 of them [8.0%] were in class I and 4 [8.0%] were in class II. One patient was in class I preoperatively and became in the same class postoperatively. As regard the mortality, preoperatively there were 16 patients [32.0%] in class II. All of them survived the operation. Fourteen patients [28.0%] were in class III, 4 of them [8.0%] died. Sixteen patients [32.0%] were in class IV preoperatively, 7 of them [14.0%] died. Four patients [8.0%] were in class V, 3 patients [6.0%] died postoperatively. As regard hepatic dysfunction, 28 patients [56.0%] were associated with hepatic dysfunction preoperatively, half of them died postoperatively, [14 patients 28.0%] while only 3 patients [6.0%] died from 22 patients [44.0%] presented with preoperative normal liver function. Preoperative PVE was associated highest mortality, staph 3 patients [6.0%], strept 2 patients [4.0%], eandida 2 patients [4.0%], crypt 1 patient [2.0%], pseudo I patients [2.0%]. As regard the cardioplogia, sixteen patients [32.0%] were given crystalloid cardioplegia, 7 patients of them [14.0%] survived and 9 patients [18.0%] died. Thirty four patients [68.0%] were given blood cartioplegia, 26 patients of them [52.0%] survived and 8 patients [16.0%] died. As regard arrhythmia, 20 patients [40.0%] were in sinus rhythm preoperatively, 5 patients [10.0%] of them died postoperatively, while 30 patients [60.0%] had AF, 12 patients [24.0%] died. Sex 23 patients [46.0%] were males, 10 patients of them [20.0%] died, while female patients were 27 [54.0%], seven of them [14.0%] died, Toxemia sixteen patients [32.0%] were in toxemia preoperatively, 10 patients of them [20.0%] died postoperatively while 34 [68.0%] presented without toxemia 7 patients of them [14.0%] died. First operations patients with previous DVR were 9 patients [18.0%] 5 of them [10.0%] died postoperatively; 1 patient [2.0%] with previous DVR and. De Vaga died; 9 patients [18.0%] with previous MVR and De Vaga, 3 patients [6.0%] of them died; 31 patients [62.0%] with previous MVR, 8 patients of them [18.0%] died postoperatively. Mitral valve redo is challenging procedure. Several risk factors affecting the survival of the patients such as gender, previous clinical stage, arrhythmia, PVE. valve thrombosis, paravalvular teak, hepatic and renal dysfunction, type of cardioplegia, toxemia, low Co, type of previous procedure, ascending aorta versus femoral cannulation