Department of General Surgery, University of KwaZulu-Natal, South Africa.
Department of Cardiothoracic Surgery, University of KwaZulu-Natal, South Africa.
S Afr J Surg. 2022 Mar;60(1):44-48.
Severe cardiac failure from mechanical mitral valve thrombosis due to poor warfarin control is a major cause of emergency redo mitral valve replacement (MVR) in South Africa. This study aimed to review the outcomes of redo MVR in patients presenting with mitral valve failure to a tertiary South African centre.
Retrospective chart review of patients undergoing redo MVR over a 10-year period (2005-2014). Patient demographics, aetiology of valve dysfunction, preoperative clinical assessment and outcomes were analysed.
Sixty-four patients had 80 mitral valve procedures. The M:F ratio was 1:2.8 and the median age was 18 (IQR 14-28.5) and 25 (IQR 18-40) at initial surgery and at redo surgery, respectively. Median interval between original and redo MVRs was 47.5 (IQR 7.5-124) months. Rheumatic valve disease was the original pathology in 58 patients (90.6%). Fifty-two patients underwent a single redo MVR and 12 patients had multiple redo MVRs. Fifty-eight (72.5%) were emergency redo procedures. Prosthetic valve thrombosis was present in 73.8%. Ten patients (15.6%) developed postoperative complications. The median hospital stay and ICU stay were 19 (IQR 12-27.5) days and 4 (IQR 3-7) days, respectively. Two patients died in the postoperative period (3.1%). The mean patient follow-up was 42 months. Three patients died during follow-up.
The majority of redo MVR procedures were undertaken as an emergency with valve thrombosis being the most common aetiology. The mortality rate was 3.1% and postoperative complication rate was 15.6%.
由于华法林控制不佳导致机械二尖瓣血栓形成引起的严重心脏衰竭是南非急诊再次二尖瓣置换术（redo MVR）的主要原因。本研究旨在回顾在南非一家三级中心因二尖瓣功能衰竭而接受 redo MVR 的患者的结局。
对 10 年间（2005-2014 年）接受 redo MVR 的患者进行回顾性病历回顾。分析患者的人口统计学资料、瓣膜功能障碍的病因、术前临床评估和结局。
64 例患者进行了 80 例二尖瓣手术。M:F 比例为 1:2.8，初始手术和 redo 手术时的中位年龄分别为 18（IQR 14-28.5）和 25（IQR 18-40）。 redo MVR 与初始 MVR 之间的中位间隔为 47.5（IQR 7.5-124）个月。58 例患者（90.6%）的原始病变为风湿性瓣膜病。52 例患者进行了单次 redo MVR，12 例患者进行了多次 redo MVR。58 例（72.5%）为急诊 redo 手术。73.8%存在人工瓣膜血栓形成。10 例（15.6%）患者术后发生并发症。中位住院时间和 ICU 住院时间分别为 19（IQR 12-27.5）天和 4（IQR 3-7）天。2 例患者术后死亡（3.1%）。平均患者随访时间为 42 个月。3 例患者在随访期间死亡。
大多数 redo MVR 手术是作为急诊手术进行的，最常见的病因是瓣膜血栓形成。死亡率为 3.1%，术后并发症发生率为 15.6%。
