Determinants of Hospital Mortality after Repeat Mitral Valve Surgery for Rheumatic Mitral Valve Disease

Abstract

Objective: The aim of this study is to detect the risk factors for hospital mortality in patients who underwent reoperative mitral valve replacement. Methods: Rheumatic mitral valve patients who underwent primary mitral valve replacement (386 cases) and repeat mitral valve replacement (94 cases) were analysed retrospectively. The incremental effects of the reoperative procedure on hospital mortality were studied by comparing primary and reoperative procedures and analyzing a series of possible predisposing factors. Results: Operative mortality for repeat procedures was found significantly higher than the first operations (respectively 12.8 % versus 4.3 %, p = 0.022). Risc factors affecting the hospital mortality in reoperation group were determined as advanced age, diameter of left atrium, prolonged bypass time and development of postoperative low output state. The indication for surgery also had a significant role in patients' outcome. Mortality found significantly higher in cases operated due to endocarditis or mitral mechanical valve thrombosis compared to other reoperation groups. Conclusion: Patients over age of 70 years, with a left atrial diameter over 60 mm, reoperated due to endocarditis and mechanical valve thrombosis, should be reevaluated for risk assessment while giving the decision of optimal operation timing. Especially patients with left ventricular hypertrophy and decreased myocardial reservoirs, efficient myocardial protection during the operation had an important role.

Key words

Mitral valve surgery - rheumatic mitral valve disease - reoperation

References

• 1 Cohn L H, Aranki S F, Rizzo R J. et al . Decrease in operative risk of reoperative valve surgery.  Ann Thorac Surg. 1993;  56 15-20 20-21
• 2 Fernandez J, Joyce D H, Hirschfeld K, Chen C, Laub G W, Adkins M S, Anderson W A, Mackenzie J W, McGrath L B. Factors affecting mitral valve reoperation in 317 survivors after mitral valve reconstruction.  Ann Thorac Surg. 1992;  54 440-447 448
• 3 Reed D, Abbott R D, Smucker M L, Kaul S. Prediction of outcome after mitral valve replacement in patients with symptomatic chronic mitral regurgitation. The importance of left atrial size.  Circul. 1991;  84 23-24
• 4 Sampath Kumar A, Dhareshwar J, Airan B, Bhan A, Sharma R, Venugopal P. Redo mitral valve surgery a long term experience.  J Card Surg. 2004;  19 303-307
• 5 Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Kawansihi Y, Uehara K. Long-term results of reoperative mitral valve surgery in patients with rheumatic disease.  Ann Thorac Surg. 2003;  76 1939-1943 1943
• 6 Lytle B W, Cosgrove D M, Taylor P C. et al . Reoperations for valve surgery: perioperative mortality and determinants of risk for 1000 patients, 1958 - 1984.  Ann Thorac Surg. 1986;  42 632-643
• 7 Sener E, Yamak B, Katircioglu S F, Ozerdem G, Karagoz H, Tasdemir O, Beyazit K. Risk factors of reoperation for prosthetic heart valve dysfunction in the ten years 1984 - 1993.  Thorac Cardiovasc Surg. 1995;  43 128-152
• 8 Detry O, Delflraigne J O, Limet R. Valve replacement for acute left heart endocarditis.  J Cardiovasc Surg. 1995;  3 529-535
• 9 Chitwood Jr W R, Wixon C L, Norton T O, Lust R M. Complex valve operations: antegrade versus retrograde cardioplegia?.  Ann Thorac Surg. 1995;  60 815-818
• 10 Allen B S, Murcia-Evans D, Hartz R S. Integrated cardioplegia allows complex valve repairs in all patients.  Ann Thorac Surg. 1996;  62 23-29
• 11 Cohn L H. Myocardial protection for reoperative cardiac surgery in acquired heart disease.  Semin Thorac Cardiovasc Surg. 1993;  5 162-167
• 12 Nicolini F, Beghi C, Muscari C, Agostinelli A, Budillon A M, Spaggiari I, Gherli T. Myocardial protection in adult cardiac surgery: current options and future challenges.  Eur J Cardiothorac Surg. 2003;  24 986-993
• 13 Buttard P, Bonnefoy E, Chevalier P. et al . Mechanical cardiac valve thrombosis in patients in critical hemodynamic compromise.  Eur J Cardiovasc Surg. 1997;  11 710-713
• 14 Potter D, Sundt T M, Zehr K J. et al . Risk of repeat mitral valve replacement for failed mitral valve prosthesis.  Ann Thorac Surg. 2004;  78 67-72
• 15 Rizzoli G, Guglielmi C, Toscana G. et al . Reoperations for acute prosthetic thrombosis and pannus: an assesment of rates, relationship and risk.  Eur J Cardiothorac Surg. 1999;  16 74-80
• 16 David T E, Bos J, Christakis G T, Brofman P R, Wong D, Feindel C M. Heart valve operations in patients with infective endocarditis.  Eur J Cardiothorac Surg. 1997;  11 46
• 17 Bauernschmitt R, Jakob H G, Vahl C F, Lange R, Hagl S. Operation for infective endocarditis: results after implantation of mechanical valves.  Ann Thorac Surg. 1998;  65 359-364
• 18 Larbalestier R I, Kinchla N M, Aranki S F, Couper G S, Collins Jr J J, Cohn L H. Acute bacterial endocarditis. Optimizing surgical results.  Circul. 1992;  86 (Suppl 5) 68-74
• 19 Yau T M, El-Ghoneimi Y A, Armstrong S, Ivanov J, David T E. Mitral valve repair and replacement for rheumatic disease.  J Thorac Cardiovasc Surg. 2000;  119 53-60
• 20 Chauvaud S, Waldmann T, d'Attellis N, Bruneval P, Acar C, Gerota J, Jarraya M, Carpentier A. Homograft replacement of the mitral valve in young recipients: mid-term results.  Eur J Cardiothorac Surg. 2003;  23 560-566
• 21 Gulbins H, Anderson I, Kilian E, Schrepfer S, Uhlig A, Kreuzer E, Reichart B. Five years of experience with mitral valve homografts.  Thorac Cardiovasc Surg. 2002;  50 223-229