Hemolytic Anemia after Mitral Valve Surgery

Objective : The aim of this study is to describe a series of patients undergoing reoperation due to hemolytic anemia after mitral valve surgery and assess the mechanisms and surgical outcomes. Methods : Between 2009 and 2014, we performed redo mitral valve surgery in 11 patients who had refractory hemolytic anemia after mitral valve surgery at Kyoto University Hospital. The mean age of the patients was 72.2 6.8 years old, and there were 5 men. Results : Preoperative echocardiography demonstrated that only 3 patients had grade 3 mitral regurgitation MRð, the rest of the patients had only mild to moderate MR. The mechanisms of severe hemolysis included paravalvular leakage PVL after mitral valve replacement MVR in 8 patients, structural valve deterioration SVD after MVR using a bioprosthesis in one, and residualörecurrent mitral regurgitation after mitral valve plasty MVP in two. All the patients except one re-MVP underwent MVR. The mean interval between previous operation and current operation was 14.1 9.4 years in post-MVR cases, and 2.0 1.9 years in post-MVP cases. There were three late deaths, one of which was due to cardiac death exacerbation of heart failure due to pneumoniað. There was one patient who required re-MVR for recurrent hemolysis due to PVL after MVR. Conclusion : Although hemolytic anemia after mitral valve surgery is rare, it often requires reoperation regardless of the degree of MR at late follow-up period. Thus, patients after mitral valve surgery should be carefully followed-up. Jpn. J. Cardiovasc. Surg. 45 : 67ô72 2016 Keywords hemolytic anemia ; mitral valve replacement ; mitral valve plasty ; paravalvular leakage ; structural valve deterioration