Why the study?
Severe cardiac failure from mechanical mitral valve thrombosis due to poor warfarin control is a major cause of emergency redo MVR in South Africa, prompting a review of outcomes at a tertiary centre.
What are the clinical outcomes and aetiologies of redo mitral valve replacement in a South African tertiary centre?
What are the clinical outcomes and aetiologies of redo mitral valve replacement in a South African tertiary centre?
In a South African tertiary centre, redo mitral valve replacement is predominantly performed as an emergency due to valve thrombosis in young patients with rheumatic heart disease, but carries an acceptable mortality rate of 3.1%.
Acceptable mortality despite mostly emergency redo MVR for thrombosis; extends RHD data in South Africa but leaves optimal anticoagulation strategies open.
BACKGROUND: Severe cardiac failure from mechanical mitral valve thrombosis due to poor warfarin control is a major cause of emergency redo mitral valve replacement (MVR) in South Africa. This study aimed to review the outcomes of redo MVR in patients presenting with mitral valve failure to a tertiary South African centre. METHODS: Retrospective chart review of patients undergoing redo MVR over a 10-year period (2005-2014). Patient demographics, aetiology of valve dysfunction, preoperative clinical assessment and outcomes were analysed. RESULTS: Sixty-four patients had 80 mitral valve procedures. The M:F ratio was 1:2.8 and the median age was 18 (IQR 14-28.5) and 25 (IQR 18-40) at initial surgery and at redo surgery, respectively. Median interval between original and redo MVRs was 47.5 (IQR 7.5-124) months. Rheumatic valve disease was the original pathology in 58 patients (90.6%). Fifty-two patients underwent a single redo MVR and 12 patients had multiple redo MVRs. Fifty-eight (72.5%) were emergency redo procedures. Prosthetic valve thrombosis was present in 73.8%. Ten patients (15.6%) developed postoperative complications. The median hospital stay and ICU stay were 19 (IQR 12-27.5) days and 4 (IQR 3-7) days, respectively. Two patients died in the postoperative period (3.1%). The mean patient follow-up was 42 months. Three patients died during follow-up. CONCLUSION: The majority of redo MVR procedures were undertaken as an emergency with valve thrombosis being the most common aetiology. The mortality rate was 3.1% and postoperative complication rate was 15.6%.
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Kistan et al. (2022) studied this question.
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