Multivariate Analysis for Operative Mortality in Obstructive Prosthetic Valve Dysfunction Due to Pannus and Thrombus Formation

Abstract

SUMMARYThe objective of the present study was to investigate the risk factors for early hospital mortality in reoperations performed for obstructive prosthetic valve dysfunction. Between January 1994 and April 2005, 63 patients underwent reoperation for obstructive prosthetic valve dysfunction. The mean age of the patients was 40.3 ± 12.8 years. The mitral valve was replaced in 47 (74.6%) patients, the aortic valve in 6 (9.5%) patients, and both valves in 10 (15.9%) patients. Forty-three (68.2%) patients underwent emergency reoperations.Early hospital mortality occurred in 13 (20.6%) patients. The ethiology of the valve dysfunction was pannus formation in 45 (71.4%) patients and thrombus formation in 18 (28.6%). Pannus and thrombus were localized at the atrial side of the prosthetic valve in 15 (23.9%) patients, at the ventricular side in 13 (20.6%), and at both sides in 35 (55.5%). Inadequate anticoagulation was diagnosed in 28 of 63 (44.4%) patients. The mean INR level in these 28 patients was 1.43 ± 0.24. In multivariate analysis, the only risk factor for early hospital mortality was left ventricular ejection fraction (P = 0.015; Odds: 0.000, 95% CI: 0.000-0.043).It is concluded reoperations for prosthetic valve dysfunction have a high mortality rate. This study revealed that left ventricular dysfunction is the major determinant of surgical mortality in patients requiring reoperation for valve dysfunction due to pannus or thrombus. (Int Heart J 2006; 47: 237-245)

Management of acute ischemic stroke occurred during thrombolytic treatment of a patient with prosthetic mitral valve thrombosis: Continuing thrombolysis on top of thrombolysis

“…Although surgery is recommended by the recent guidelines (2) for patients in New York Heart Association class III-IV unless surgery is high risk, it has high mortality up to 64% (9). Thrombolysis is an effective therapy for PHVT.…”

Recurrent pannus formation causing prosthetic aortic valve dysfunction: Is excision without valve re-replacement applicable?

“…Multifactors are involved in its formation. Basically, pannus represent a bioreaction to prosthetic valves associated with coexisting factors such as surgical technique, thrombus organization from inadequate anticoagulation, infection and wall shear stress [3,4]. …”

Diagnosis and treatment of left-sided prosthetic valve thrombosis

“…In 30 patients with left-sided PVT, Ozkokeli et al reported a surgical mortality of 7.1% in NYHA II-III and 31% in NYHA IV [40]. Surgical mortality reported by Toker et al in 63 cases was 20% [41]. In another series, surgical mortality was 36% in OPVT [9].…”

“…In one study in OPVT patients presenting in class IV, mortality of thrombolysis was 13% and that of surgery 33% [9]. A review of the literature showed overall mortality among 89 patients in NYHA class IV to be 7% with thrombolysis [9,52] and ranging from 17 to 54% in operated patients [1][2][3][4]32,41], whereas in NYHA class I-III patients, mortality was no more than 5% with both treatment modalities [9,36,46,57,61,70].…”