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Analysis of Dysfunctioning Mechanical Prostheses Excised from the Mitral Valve Position.
William C Roberts1, Yusuf M Salam2
1Baylor Scott & White Heart and Vascular Institute; Departments of Internal Medicine (Division of Cardiology); Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
The American Journal of Cardiology
|June 25, 2022
Summary
Mechanical mitral valve prostheses often fail due to thrombus or pannus, necessitating replacement. Surgical outcomes depend on the explanting surgeon's technique, with early mortality observed in 19% of patients.
Area of Science:
- Cardiovascular Surgery
- Prosthetic Heart Valves
- Cardiac Surgery Outcomes
Background:
- Mechanical mitral valve prostheses are used for valve replacement.
- These prostheses can dysfunction over time due to various complications.
- Complications include stenosis, regurgitation, thrombus, pannus, and paravalvular leaks.
Purpose of the Study:
- To report findings on patients undergoing replacement of malfunctioning mechanical mitral valve prostheses.
- To analyze causes of mechanical mitral valve prosthesis dysfunction.
- To evaluate early and late outcomes following prosthesis explantation and replacement.
Main Methods:
- Retrospective analysis of 16 patients with explanted mechanical mitral valve prostheses.
- Review of reasons for prosthesis dysfunction, including thrombus, pannus, and paravalvular leak.
- Assessment of surgical methods used for prosthesis excision and patient survival rates.
Main Results:
- 16 patients underwent mechanical mitral valve prosthesis replacement.
- Dysfunction was primarily due to non-infective causes (thrombus, pannus, leak) in 13 patients.
- Early post-operative mortality was 19% (3 patients); 13 patients survived over 1 year.
Conclusions:
- Mechanical mitral valve prostheses can dysfunction due to non-infective complications like pannus and thrombus, even with warfarin therapy.
- Explantation and replacement of these prostheses carry significant early mortality risk.
- The success of prosthesis excision appears to be highly dependent on the surgeon's expertise.
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