ARE THERE PREDICTORS OF POST OPERATIVE OUTCOME IN PATIENTS UNDERGOING MITRAL VALVE REPLACEMENT FOR RHEUMATIC VALVULAR HEART DISEASE?

Abstract

Background: Rheumatic heart disease is the most common cause of valvular heart disease in developing
countries. Frequently patients present quite late in their disease course. We sought to determine the
predictors of post operative outcome in patients undergoing mitral valve replacement for rheumatic heart
disease.

Methods: This retrospective study was conducted in Shifa International hospital, Islamabad from February
2003 to December 2006. 34 patients underwent mitral valve replacement due to rheumatic mitral valve
disease. All patients had their demographic characteristics, operative details and comprehensive
preoperative and post operative echocardiographic parameters recorded. Data was analyzed using SPSS
V.13 statistical software.

Results: Mean age of the study population was 35.09±10.52 years with female predominance (n =23, 67.6 %).
After a mean follow-up of 187.2±17.51 days, the ability of preoperative and postoperative clinical and
echocardiographic data to predict outcome and the impact of valve replacement on survival was assessed
retrospectively. 30 patients (88.2%) underwent mitral valve Replacement due to underlying isolated
rheumatic mitral valve while 4 patients (11.8%) had both mitral and aortic valve replacement. 12 patients
(35.3%) had tricuspid valve annuloplasty done during the same operation. There were no perioperative
deaths. There were 2 (5.9%) deaths after a mean period of 162±12 days as a result of prosthetic valve
thrombosis. Comparison of pre operative and post operative echocardiographic data revealed statistically
significant reduction in pulmonary artery systolic pressure in 28 patients (p-value 0.001), reduction in left
atrial size in 31 patients (p-value 0.001) and reduction in right ventricular dimensions in 25 patients (p-value
0.001). Actual probability of freedom from ytlve related death, including in-hospital mortality, at cumulative
follow up duration of 25.76±17.62 mrn hs was 94.1% irrespective of preoperative echocardiograpgic
parameters, mono or bivalvular rep acement and post procedural congestive cardiac failure or
thromboembolic events.