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  • Meeting abstract
  • Open Access

Results of surgical management in mechanical mitral valve thrombosis

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Journal of Cardiothoracic Surgery201510 (Suppl 1) :A188

https://doi.org/10.1186/1749-8090-10-S1-A188

  • Published:

Keywords

  • Pulmonary Edema
  • Hemodynamic Instability
  • NYHA Class
  • Mechanical Valve
  • Operative Morbidity

Background/Introduction

Valve thrombosis is a serious complication of heart valve surgery. It most often involves mechanical valve in mitral position and may be life-threatening in the short term period, necessitating prompt treatment. Among therapeutic options, surgery leads to complete success of deobstruction but with a high morbi-mortality rate.

Aims/Objectives

The purpose of this study is to review the results of our experience in surgical management of mechanical mitral valve thrombosis.

Method

This is a retrospective study including fifteen patients operated on in our institution for mitral valve thrombosis between 2012 through 2014. Ten patients (66.7%) were operated on as emergent cases (within 24 h after admission) and five patients (33.3%) were elective (3-5 days after admission). Mean age was 45 years and 12 were females. All patients had a mechanical valve implanted in the mitral position; mean time between first and second intervention was 3.9 years [7 day-19 years]. Clinically 14 patients (93.3%) were in NYHA stage III-IV on admission, seven had pulmonary edema (46.7%) and 6 had hemodynamic instability (40%) necessitating inotropic support. Mean preoperative mitral gradient was 26.4 mmHg. All patients underwent a surgical procedure, consisting of valve replacement in 14 patients and thrombectomy in one case. Five patients had associated tricuspid annuloplasty.

Results

Six patients died postoperatively which represents a 40% mortality rate. This occurred mainly in patients with hemodynamic instability and NYHA class IV. Good results were achieved in patients with stable clinical status (NYHA class II-III) with no mortality in this group. All other patients were discharged after an uneventful postoperative course and no patients had recurrence of valve thrombosis at a mean follow up of 17 months.

Discussion/Conclusion

MVT is a serious complication with a dark spontaneous prognosis. It management should be as short as possible between diagnosis and intervention. In stable cases, surgery leads to good results with low morbi-mortality rates. In case of hemodynamic instability, other alternatives should be considered, including thrombolysis because operative morbidity and mortality remain high in these cases.

Authors’ Affiliations

(1)
Department of Cardiac Surgery, 1st November Hospital, Oran, 31000, Algeria

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