IS DECLOTTING A BETTER PROCEDURE THAN REDO MVR FOR STUCK MITRAL VALVE?

Abstract

Objective: To evaluate and compare the outcome of declotting versus Redo Mitral Valve replacement for stuck mitral valve in the early postoperative period.

Study Design: Retrospective interventional study.

Place and Duration of Study: Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFICNIHD) Rawalpindi from 1st Jan, 2010 to 31st Oct, 2013.

Patients and Methods: A total of 36 patients were selected. Group A (n = 28) underwent declotting & group B (n = 08) were treated by redo mitral valve replacement (MVR). Diagnosis of prosthetic valve obstruction was made on the basis of history, clinical examination, echocardiography and fluoroscopy. All patients were operated under general anesthesia & cardiopulmonary bypass (CBP). Total clamp and CPB time were recorded. Post operatively, patients were evaluated with daily progress parameter. The hemodynamic status, isotropic support, ventilation time, intensive care ward and total hospital stay were also recorded for comparison. Two-dimensional echocardiography was done before extubation and at discharge. Mortality rate was also compared in the two groups.

Result: No statistical difference was found on the basis of gender, age, interval between initial mitral valve replacement (MVR) and redo operation or decloting, anticoagulation status, New York Heart Association (NYHA) functional class, international normalized ratio (INR) level, trans thoracic echocardiography and fluoroscopy. The mean CBP time & cross clamp time was significantly less in group A than group B. Similarly mean ventilation time in group A was significantly less than in group B. The mean ITC stay was & mean hospital stay was not statistically significant. The mortality rate in group A & B was 7.14% & 50% respectively which was statistically significant.

Conclusion: Prosthetic valve thrombosis is a life threatening complication after mechanical mitral valve replacement with high mortality without timely and effective surgical intervention. Declotting, being a less aggressive surgical technique is recommended because of better outcome in terms of morbidity and mortality in the early post-operative period.