Acute mechanical valve dysfunction: Alexandria ... - cardioegypt2011
Acute mechanical valve dysfunction: Alexandria ... - cardioegypt2011
Acute mechanical valve dysfunction: Alexandria ... - cardioegypt2011
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<strong>Acute</strong> <strong>mechanical</strong> <strong>valve</strong><br />
<strong>dysfunction</strong>:<br />
<strong>Alexandria</strong> experience<br />
Prof. Dr. Wael Hassanein, Prof. Dr. Ahmed Saleh<br />
Sharmelsheikh, October 2011<br />
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Although the incidence of Rheumatic fever in<br />
industrialized countries has greatly decreased,<br />
rheumatic carditis still results in significant<br />
morbidity and mortality in developing countries<br />
with increasing numbers of patients requiring<br />
intervention for their valvular heart disease<br />
yearly.<br />
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100<br />
90<br />
80<br />
70<br />
60<br />
50<br />
40<br />
30<br />
20<br />
10<br />
0<br />
Percent of <strong>mechanical</strong> <strong>valve</strong> implantations to all<br />
cardiac operations in <strong>Alexandria</strong> University<br />
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2005 2006 2007 2008 2009 2010<br />
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1200<br />
1000<br />
800<br />
600<br />
400<br />
200<br />
0<br />
The cumulative number of patients with<br />
<strong>mechanical</strong> <strong>valve</strong> implantations in <strong>Alexandria</strong><br />
University since 2005<br />
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2005 2006 2007 2008 2009 2010<br />
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20<br />
18<br />
16<br />
14<br />
12<br />
10<br />
8<br />
6<br />
4<br />
2<br />
0<br />
The number of patients presented with acute<br />
<strong>mechanical</strong> <strong>valve</strong> <strong>dysfunction</strong><br />
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2005 2006 2007 2008 2009 2010<br />
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• The aim of this work is to analyze the results of<br />
emergency surgical management of patients<br />
with acute <strong>mechanical</strong> <strong>valve</strong> <strong>dysfunction</strong>.<br />
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• All patients with acute <strong>mechanical</strong> <strong>valve</strong><br />
<strong>dysfunction</strong> presented to the Cardiothoracic<br />
Surgery department in <strong>Alexandria</strong> Main<br />
University hospital from January 2005 till<br />
November 2010 were included in the study.<br />
• Univariate analysis was performed and a logistic<br />
regression model was calculated for the<br />
postoperative mortality.<br />
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Operated<br />
patients; 72<br />
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Preoperative<br />
mortalities;<br />
11<br />
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Mitral <strong>valve</strong>;<br />
46<br />
Double; 2<br />
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Aortic <strong>valve</strong>;<br />
24
Male; 42<br />
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Female; 30<br />
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45<br />
40<br />
35<br />
30<br />
25<br />
20<br />
15<br />
10<br />
5<br />
0<br />
Mitral<br />
Age<br />
41. 66<br />
34.33<br />
28.17<br />
Aortic<br />
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39.33<br />
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Male<br />
Female
7<br />
6<br />
5<br />
4<br />
3<br />
2<br />
1<br />
0<br />
Time between implantation and <strong>valve</strong><br />
<strong>dysfunction</strong><br />
3.4 ± 2.25<br />
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Mitral<br />
6.75 ± 4.5<br />
Aortic<br />
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48, 67%<br />
Preoperative risk factors<br />
Oliguria<br />
24, 33%<br />
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Oliguria<br />
Good UO<br />
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Preoperative risk factors<br />
55, 76%<br />
Pulmonary edema<br />
17, 24%<br />
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P Eo<br />
No P Eo<br />
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Preoperative risk factors<br />
61, 85%<br />
Mechanical ventilation<br />
11, 15%<br />
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Ventilated<br />
Non-ventilatd<br />
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44, 61%<br />
Preoperative risk factors<br />
Inotropic support<br />
28, 39%<br />
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Inotropes<br />
No Inotropes<br />
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Explanted <strong>valve</strong>s<br />
Monoleaflet;<br />
3<br />
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Bileaflet; 71<br />
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Postoperative mortality<br />
80<br />
60<br />
40<br />
20<br />
0<br />
12.5%<br />
9<br />
63<br />
13%<br />
6<br />
40<br />
12.5% 37.5%<br />
3<br />
21<br />
41.2% 54.5%<br />
9<br />
7<br />
15 10<br />
6<br />
5<br />
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P
• The multiple regression model confirmed that<br />
preoperative oliguria, pulmonary edema,<br />
<strong>mechanical</strong> ventilation and inotropic support are<br />
independent risk factors for postoperative<br />
mortality.<br />
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Postoperative data<br />
Range<br />
Mean ± SD<br />
Postoperative bleeding (ml) 100 – 1600 506.94 ± 381.73<br />
Mechanical ventilation<br />
(hours)<br />
4 – 30 12.56 ± 7.99<br />
ICU stay (days) 2 – 10 5.33 ± 2.09<br />
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Postoperative data<br />
• 6 cases needed re-exploration for excessive<br />
bleeding (8.33%).<br />
• One patient had postoperative stroke with<br />
permenant right hemiplegia (1.4%).<br />
• 6 patients had superficial wound infection<br />
(8.33%)<br />
• 2 patients needed permenant pacemaker (2.8%)<br />
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• Emergency <strong>mechanical</strong> <strong>valve</strong> re-replacement<br />
carries a significant perioperative mortality.<br />
• Prompt surgical intervention before the<br />
development of advanced pulmonary and renal<br />
complications is the most important factor to<br />
decrease the operative mortality.<br />
• Continuous improvement of the process<br />
management is needed to shorten the time<br />
between admission and operation.<br />
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