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[Third mitral valve replacement--review of clinical aspects and surgical management in 10 cases]
Insights
Third mitral valve replacement (3rd MVR) is increasingly common. This study found that while the risk of 3rd MVR is higher than initial replacements, operative risks have decreased with improved strategies.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair and Replacement
- Prosthetic Valve Malfunction
Context:
- Third mitral valve replacement (3rd MVR) procedures are becoming more frequent.
- Limited data exists on the specific determinants and outcomes of 3rd MVR.
- This study analyzes 10 patients undergoing 3rd MVR between 1986 and 1995.
Purpose:
- To evaluate the backgrounds, risks, and complications associated with third mitral valve replacement.
- To compare the incremental effect of 3rd MVR on hospital mortality and morbidity versus first (1st MVR) and second mitral valve replacement (2nd MVR).
Summary:
- The study reviewed 10 patients (average age 58) who underwent 3rd MVR due to prosthetic valve malfunction (tissue failure, leakage, endocarditis).
- The overall mortality rate was 10%, with death attributed to low cardiac output syndrome and multiple organ failure.
- The primary indications for 3rd MVR were congestive heart failure from tissue failure (65%), paravalvular leakage (20%), and prosthetic valve endocarditis (15%).
Impact:
- Surgical risk for 2nd MVR and 3rd MVR is higher than for 1st MVR, though the difference between 2nd and 3rd MVR is not statistically significant.
- Improved intraoperative strategies have significantly reduced the operative risk for patients undergoing 3rd MVR.
- Findings contribute to understanding the outcomes and management of complex mitral valve reoperations.
Abstract:
Third mitral valve replacement (3rd MVR) have become more frequent as use of replacement procedures has become more widespread. However, little information exists to clearly document the determinants of 3rd MVR. To evaluate backgrounds and risks and complications of 3rd MVR, we reviewed data on 10 patients (6 male and 4 female, age averaged 58 +/- 8 years) who underwent 3rd MVR because of prosthetic valve malfunction during December 1986-May 1995. This represented 7.1% of total number of reoperations for valve surgery (10/140) during that period. The incremental effect of the 3rd MVR on hospital mortality and mobidity was studied by comparing first mitral valve replacement (1st MVR) and second mitral valve replacement (2nd MVR) and 3rd MVR. After an interval of 134 +/- 23 months, 3rd MVR was undertaken for congestive heart failure due to primary tissue failure in 65%, paravalvular leakage in 20%, prosthetic valve endocarditis in 15%. One patient died at 11 days postoperatively, for a mortality rate of 10%. Cause of death was related to multiple organ failure due to low cardiac output syndrome. The surgical risk of 2nd MVR and 3rd MVR is higher than that of 1st MVR, but there is no conclusive evidence that the difference between 2nd MVR and 3rd MVR is statistically significant. With improvement intraoperative strategies, the operative risk in patients undergoing 3rd MVR has been markedly reduced.