Redo surgery risk in patients with cardiac prosthetic valve dysfunction

Maciejewski, Marek; Piestrzeniewicz, Katarzyna; Bielecka‐Dąbrowa, Agata; Piechowiak, Monika; Jaszewski, Ryszard

doi:10.5114/aoms.2011.22078

Cited by 13 publications

(12 citation statements)

References 24 publications

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“…Patients presented with valve obstruction and low blood pressure are prone to kidney injury which further leads to fluid retention and exaggerates the heart failure. In agreement with other studies, the previous stroke was associated with higher mortality [20]. Stroke can occur due to concomitant carotid disease or embolization from left atrial thrombus.…”

Section: Discussionsupporting

confidence: 92%

“…Mortality in the current study was significantly associated with long CPB and cross-clamp times which is consistent with the published series [16,19,23]. The cause of the prolonged CPB time was the lengthy weaning from the circulatory support because of the associated poor left ventricular function [20] which is a risk factor for morality [24,25].…”

Section: Discussionsupporting

confidence: 89%

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Outcome Prediction after Surgical Management of Prosthetic Mitral Valve Dysfunction; a single center experience

Badr

Elanwar

2019

Egypt. Cardiothoracic. Surg.

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Background: Prosthetic Mitral valve dysfunction is a serious complication associated with a high mortality rate particularly in obstructive cases. The number of cases undergoing redo mitral valve surgery is increasing. This study aims to identify the risk factors of mortality and morbidity in patients who underwent redo mitral valve surgery for prosthetic mitral valve dysfunction. Methods: This study was conducted on 80 patients who underwent re-operation for management of prosthetic mitral valve dysfunction from December 2014 to February 2018. Patients' age ranged between 21 and 58 years with a mean of 36.8±9.60 years, and 53 patients (66.3%) were males. The causes of mitral valve malfunction were thrombus in 67 patients (83.7%) and pannus in 13 patients (16.3%). Results: 53 patients (66.25%) had urgent surgical intervention. Thrombectomy or pannus resection was done in 75 patients (93.75%) and valve replacement in 5 patients (6.25%). Re-exploration was required in 11 patients (13.75%) and was significantly associated with diabetes (p= 0.004), preoperative liver dysfunction (p= 0.04), elevated INR (p= 0.006), trial of thrombolysis (p<0.001) and prolonged ischemic time (p= 0.01). Postoperative renal failure occurred in 11 patients (13.75%) and was associated with diabetes (p< 0.001), preoperative renal dysfunction (p< 0.001), prolonged cardiopulmonary bypass and ischemic times (p< 0.001). 17 patients (21%) required prolonged mechanical ventilation and it was significantly associated with chronic obstructive lung disease (p< 0.001), pulmonary edema (p <0.001), low systolic blood pressure (p <0.001), low ejection fraction (p<0.001) and thrombectomy (p<0.001). Operative mortality occurred in 13 patients (16%) and was significantly associated with preoperative stroke, renal dysfunction, low blood pressure and acute pulmonary edema (p <0.001). Conclusion: Reoperation for prosthetic mitral valve dysfunction is associated with high morbidity and mortality. Outcomes can be predicted based on preoperative clinical status and operative times. Thrombectomy and pannus resection with the repair of the paravalvular leak is a simple and easy technique for management of those patients with a reduction of cardiopulmonary bypass and cross-clamp times.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Outcome Prediction after Surgical Management of Prosthetic Mitral Valve Dysfunction; a single center experience

Badr

Elanwar

2019

Egypt. Cardiothoracic. Surg.

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“…Additionally, both women were in poor biological condition. Moreover, redo procedures are always associated with higher risk [ 8 ]. On the other hand, some authors have proved that reoperation is not an independent risk factor for operative mortality.…”

Section: Discussionmentioning

confidence: 99%

Artificial aortic valve dysfunction due to pannus and thrombus – different methods of cardiac surgical management

Ostrowski

Marcinkiewicz

Kośmider

et al. 2015

kitp

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IntroductionApproximately 60 000 prosthetic valves are implanted annually in the USA. The risk of prosthesis dysfunction ranges from 0.1% to 4% per year. Prosthesis valve dysfunction is usually caused by a thrombus obstructing the prosthetic discs. However, 10% of prosthetic valves are dysfunctional due to pannus formation, and 12% of prostheses are damaged by both fibrinous and thrombotic components. The authors present two patients with dysfunctional aortic prostheses who were referred for cardiac surgery. Different surgical solutions were used in the treatment of each case.Case study 1The first patient was a 71-year-old woman whose medical history included arterial hypertension, stable coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and hypercholesterolemia; she had previously undergone left-sided mastectomy and radiotherapy. The patient was admitted to the Cardiac Surgery Department due to aortic prosthesis dysfunction. Transthoracic echocardiography revealed complete obstruction of one disc and a severe reduction in the mobility of the second. The mean transvalvular gradient was very high. During the operation, pannus covering the discs’ surface was found. A biological aortic prosthesis was reimplanted without complications.Case study 2The second patient was an 87-year-old woman with arterial hypertension, persistent atrial fibrillation, and COPD, whose past medical history included gastric ulcer disease and ischemic stroke. As in the case of the first patient, she was admitted due to valvular prosthesis dysfunction. Preoperative transthoracic echocardiography revealed an obstruction of the posterior prosthetic disc and significant aortic regurgitation. Transesophageal echocardiography and fluoroscopy confirmed the prosthetic dysfunction. During the operation, a thrombus growing around a minor pannus was found. The thrombus and pannus were removed, and normal functionality of the prosthetic valve was restored.ConclusionsPrecise and modern diagnostic methods facilitated selection of the treatment method. However, the intraoperative view also seems to be crucial in individualizing the surgical approach.

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“…Recently, Maciejewski et al. evaluated 194 patients undergoing redo valve surgery (aortic or mitral) and quoted a 30‐day mortality rate of 18.6% . The authors found that NYHA class III–IV and infective endocarditis were significant multivariable predictors of mortality.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Assessment of Left Ventricular Diastolic Function and Right Ventricular Systolic Function Have Independent and Incremental Prognostic Value in Prediction of Early Postoperative Mortality in Redo Valve Surgery

2014

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Comprehensive preoperative echocardiography including assessment of left ventricular diastolic and right ventricular systolic function has independent prognostic value over and above EuroSCORE II in the prediction of early postoperative mortality in patients undergoing redo valve surgery. The results of preoperative echocardiography should be taken into account during the selection and perioperative management of patients undergoing redo valvular surgery.

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Redo surgery risk in patients with cardiac prosthetic valve dysfunction

Cited by 13 publications

References 24 publications

Outcome Prediction after Surgical Management of Prosthetic Mitral Valve Dysfunction; a single center experience

Outcome Prediction after Surgical Management of Prosthetic Mitral Valve Dysfunction; a single center experience

Artificial aortic valve dysfunction due to pannus and thrombus – different methods of cardiac surgical management

Preoperative Assessment of Left Ventricular Diastolic Function and Right Ventricular Systolic Function Have Independent and Incremental Prognostic Value in Prediction of Early Postoperative Mortality in Redo Valve Surgery

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