Jignesh Kothari1, Kartik Patel2, Bhavin Brahmbhatt3, Kinnaresh Baria3, Malkesh Talsaria3, Sanjay Patel4, Sandeep Tailor5. 1. Professor, Department of Cardiothoracic and Vascular Surgery, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India . 2. Assistant Professor, Department of Cardiothoracic and Vascular Surgery, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India . 3. Resident, Department of Cardiothoracic and Vascular Surgery, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India . 4. Research Assistant, Department of Research, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India . 5. Perfusionist, Department of Perfusion, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India .
Abstract
INTRODUCTION: Prosthetic Valve Thrombosis (PVT) remains a significant cause of morbidity and mortality after valve replacement. Although surgical treatment is usually preferred as life-saving in cases of obstructive PVT, optimal treatment is yet to be decided. AIM: To evaluate risk factors and outcome of the patients undergoing redo mitral valve surgery for acute PVT. MATERIALS AND METHODS: Between January 2012 and February 2015, 65 patients underwent redo surgery for obstructive PVT of mitral valve in Department of Cardiothoracic Surgery, UN Mehta Institute of Cardiology & Research Centre. Patients having acute PVT of aortic valve or combined aortic and mitral valve were excluded. Pre-operative, intra-operative and post-operative factors affecting the outcome as well as follow-up data were measured. RESULTS: There were total 65 patients, 17 males and 48 females. Most common presenting symptom was dyspnea (100%), followed by palpitation (57.88%) and fatigue (29.45%). Total mortality was 29.2% (19/65). Mortality rate was significantly higher (16/35, 46%) in patients with direct surgery (Group-2) as compared to those with failed thrombolysis (3/30, 10%) (Group-1). Mortality was also significantly higher in patients presented with New York Heart Association (NYHA) III/IV class as compared to those presented with NYHA I/II class (p=0.02). All survived patients are NYHA Class I-II in follow-up with mean follow-up period was 24 ± 9 months. CONCLUSION: PVT still remains a challenging problem in a post-operative patient with a high mortality independent of treatment modality. Though life-saving, the surgical management of this condition still carries a high risk in haemodynamically unstable and in NYHA class III/IV patients.
INTRODUCTION: Prosthetic Valve Thrombosis (PVT) remains a significant cause of morbidity and mortality after valve replacement. Although surgical treatment is usually preferred as life-saving in cases of obstructive PVT, optimal treatment is yet to be decided. AIM: To evaluate risk factors and outcome of the patients undergoing redo mitral valve surgery for acute PVT. MATERIALS AND METHODS: Between January 2012 and February 2015, 65 patients underwent redo surgery for obstructive PVT of mitral valve in Department of Cardiothoracic Surgery, UN Mehta Institute of Cardiology & Research Centre. Patients having acute PVT of aortic valve or combined aortic and mitral valve were excluded. Pre-operative, intra-operative and post-operative factors affecting the outcome as well as follow-up data were measured. RESULTS: There were total 65 patients, 17 males and 48 females. Most common presenting symptom was dyspnea (100%), followed by palpitation (57.88%) and fatigue (29.45%). Total mortality was 29.2% (19/65). Mortality rate was significantly higher (16/35, 46%) in patients with direct surgery (Group-2) as compared to those with failed thrombolysis (3/30, 10%) (Group-1). Mortality was also significantly higher in patients presented with New York Heart Association (NYHA) III/IV class as compared to those presented with NYHA I/II class (p=0.02). All survived patients are NYHA Class I-II in follow-up with mean follow-up period was 24 ± 9 months. CONCLUSION: PVT still remains a challenging problem in a post-operative patient with a high mortality independent of treatment modality. Though life-saving, the surgical management of this condition still carries a high risk in haemodynamically unstable and in NYHA class III/IV patients.
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