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  • Title: [Mitral valve replacement in Réunion Island. Short- and medium-term results].
    Author: el Issa A.
    Journal: Ann Cardiol Angeiol (Paris); 1996; 45(7):377-82. PubMed ID: 8952732.
    Abstract:
    Mitral valve surgery represents 34.6% of all open heart surgery in our unit. The aim of this study is to assess the early and intermediate term results in a consecutive series of 81 mitral valve replacements (mechanical: 67, bioprosthesis: 14) performed between September 1991 and December 1993. The mean age was 45.7 +/- 15 years (male 26, female 55). Twenty five patients (30.9%) were classified as functional class II of the New York Heart Association classification (NYHA) and 56 (89.1%) as class III or IV. Eight were operated in an emergency. Acute rheumatic fever (49.3%) and bioprosthetic dysfunction were the two main etiologies. Thirty patients (37%) had a history of previous cardiac surgery. Hospital mortality was 13.8% (11 patients). Risk factors associated with high operative mortality were: age, emergency, previous cardiac surgery, atrial fibrillation and tricuspid annuloplasty. All survivors were contacted. Mean follow-up was 30.8 +/- 9 months (range: 3.1-46.4). Five patients had died by the last date of follow-up. Actuarial survival at 1 and 4 years was 86% and 77%, respectively. Late events were mainly 9 episodes of thrombosis, 3 cases of thrombo-embolism and 1 peri-prosthetic leak; five patients were reoperated. The linearized incidence of these events was respectively: 5.1%, 1.7%, 0.5% and 3.4% per patient/year, respectively. There were no complications in case of bioprostheses. Functional improvement was satisfactory and 93% of patients were in NYHA class I or II at the most recent follow-up. Functional results after mitral valve replacement were satisfactory, regardless the type of prosthesis; however valve-related complications are very serious. Conservative mitral surgery is currently our first choice whenever possible.
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