Research Article

Impact of Valve Pathology on Outcome of the Modified Preservation of Mitral Valve Apparatus during Mitral Valve Replacement

Authors: Hamdy D Elayouty, Hassan Salah Hassan, Mohamed Sami Hamed, Ahmed Hamdy Elayouty.

DOI: 10.33425/2639-8486.1213

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Abstract

Objectives: To assess impact of valve pathology on outcome of the modified preservation of mitral valve apparatus during mitral valve replacement.

Methods: This prospective descriptive study included 50patients with rheumatic mitral valve disease (group A) and non-rheumatic (group B): B1:25 patients with ischemic mitral lesions and B2:25patients with degenerative valve lesions admitted between 1st March 2022 and 28th Feb.2024 at one center. All patients had modified preservation of mitral apparatus during prosthetic mitral replacement. Additionally, Group B1 had bypass grafts to diseased coronary arteries. Group B2 had chordal transposition, folding and/ or reattachment.

Results: Pre-operative data did not show significant differences between groups (p>0.05.) but the smoking index was much higher in group B. Intraoperative Trans-Esophageal Echocardiography showed free mobility of prosthetic leaflets, left ventricular outflow tract free of any obstruction and freedom from any valve-related complications in the groups.

Cross-clamp and recovery times were shorter in group A (p=0.0001) & early mortality of 2patients. Group B: post-operative inotrope requirements were significantly larger, three died after failure of weaning from intra-aortic balloon pump. Three others needed coronary angiogram and stenting due to the occlusion of one of the grafts 3 and 7 months after surgery. One in group A and another in group B died after thrombo-embolic events

Improved left ventricular functions were reported 6, 12 and 24-months after surgery. Left ventricular and atrial dimensions were reduced among groups.

Conclusions: This technique is feasible and reproducible for rheumatic and non-rheumatic valve lesions due to freedom from mid-term reoperation, preserved ventricular functions and acceptable value-related complication rates.

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