Left ventricular rupture after mitral valve replacement: risk factor analysis and outcome of resuscitation

Left ventricular (LV) rupture is a rare but lethal complication after mitral valve replacement (MVR). Hence, the occurrence of LV rupture after MVR and the outcome of resuscitation was assessed.

Between January 1991 and June 2005, a total of 258 patients underwent MVR at the authors' institution. Thirteen preoperative factors and 13 surgical factors were analyzed to assess the incidence of LV rupture after MVR.

Among the patients, there were six cases of LV rupture (2.3%). Age >69 years (p = 0.0174), hemodialysis (p = 0.0119), echocardiographic end-diastolic left ventricular diameter (Dd) <50 mm (p = 0.0104), resection of the basal chorda of the posterior leaflet (p = 0.0086), mitral annular reconstruction (p = 0.009), and additional left atrial plication (p = 0.0269) were each considered as significant risk factors for LV rupture following MVR. All ruptures were type III. There were two hospital deaths (mortality 33%). At more than one year after surgery, all surviving patients were in reasonable health.

Older age, hemodialysis, and Dd <50 mm are significant risk factors for LV rupture after MVR. Preservation of the basal chordae of the posterior leaflet was important to prevent LV rupture, while endocardial patch repair with elective intraaortic balloon pumping was suggested as an effective treatment for type III rupture.