Zahira Zouizra
Cadi Ayyad University, Morocco
Title: Multiple valve surgery for advanced rheumatic heart disease: results and risk factors in 162 patients: Experience of cardiovascular surgery unit Mohammed VI University Hospital Center-Marrakech Mohammed VI-Marrakech
Biography
Biography: Zahira Zouizra
Abstract
Background: Multiple Valve Surgery (MVS) is still of choice for advanced rheumatic heart disease (RHD), which has been associated with reported poor early and late outcomes. We review our experience and results after MVS.
Methods: Between 2007 and 2017: 162 patients (53%men, 47%women), with mean age of 37.5 years (16- 67Y), underwent MVS for isolated advanced RHD. Criteria for selecting patients: New York Heart Association (NYHA) class III or IV, Cardiomegaly, lower left ventricular ejection fraction (LVEF), severe pulmonary hypertension and or right ventricular dysfunction, Valvular disease with deterioration of more than one vital function. All patients received replacement procedures in mitral and aortic position (155 mechanical, 7 bioprosthetic), with concomitant De Vega tricuspide annuloplasty (129 patients), tricuspide annuloplasty ring (11 patients) and or other complex tricuspide plasty procedures. The mean cardiopulmonary bypass time: 135 min (75 - 240min), Mean cross-clamping time: 67min (45 - 120min).
Results: The 30-day hospital mortality was 17.2% (n =28), 30 patients had postoperative complications : Low Cardiac output syndrome(12), 6 Infections (1 mediastinitis, 5 Pneumonia), 5 Acute kidney failure (Dialysis: 1 case), 7 Transient atrioventricular Block, 5 transient tachyarrythmias, 3 Neurologic events (2 Stroke, 1 Coma), 4 Right sided Heart failures.
Follow-up 3- 58 months after surgery: The freedom from thromboembolism and anticoagulation-related hemorrhage was 81 %. Of the 125 patients still alive, 98 were in NYHA class I and II.
Conclusion: Surgery of advance multiple valves disease has a significant high morbidity and mortality rates. Results may be improved by early surgical treatment before NYHA class IV or deterioration of LVEF occurs.