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Year : 2019  |  Volume : 2  |  Issue : 4  |  Page : 303-310

Surgical outcomes of obstructive mechanical valve thrombosis, risk factors, and comorbidity analysis

Cardiothoracic Department, National Heart Institute, Cairo, Egypt

Correspondence Address:
Ahmed Shafeek Ali
Cardiothoracic Department, National Heart Institute, Cairo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JMISR.JMISR_61_19

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Background Obstructive mechanical valves thrombosis is a life-threatening complication associated with high morbidity and mortality. Although thrombolytic therapy has gained a lot of popularity in recent years, yet the treatment of choice is still controversial. Objective The aim of this study was to evaluate the outcomes of patients who underwent redo valve surgery for obstructive mechanical valve thrombosis. Patients and methods Outcomes of 380 patients who underwent emergency redo surgery for obstructive mechanical valve thrombosis at our institute during a 5-year period (January 2012 to December 2017) were reviewed retrospectively. Clinical symptoms and transthoracic echocardiography were the mainstay in diagnosis. Fluoroscopy was used in the presence of dilemma regarding diagnosis. All patients were treated on an emergency basis. Postoperative outcomes were analyzed to determine risk factors and comorbidities affecting mortality rates in this high-risk group of patients. Results Number of patients was 380, with prevalence of female sex being 268 (70.52%). Mean age was 32.65 ± 10.70 years. Associated comorbidities were hypertension in 96 (25.26%), diabetes mellitus in 32 (8.42%), elevated liver enzymes in 32 (8.42%), elevated creatinine in 44 (11.57%), and preoperative cardiac arrest in eight (2.10%). Overall mortality was seen in 52 (13.68%) patients. Risk factors influencing mortality rates were preoperative hemodynamic instability, increased NYHA class, renal dysfunction, low left ventricular ejection fraction, and right ventricle dysfunction. Moreover, mortality was significantly affected by repetition of redo surgery, long bypass and cross-clamp time, high postoperative cardiac support, duration of mechanical ventilation, and ICU stay. Conclusion Prosthetic valve thrombosis is a life-threatening situation associated with substantial risk regardless of treatment modality. Late presentation with hemodynamic instability, increased NYHA class, low left ventricular ejection fraction, and severe right ventricle dysfunction carry worst prognosis in surgically treated patients.

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