Short Term Outcome of Double Valve Replacement vs. Aortic Valve Replacement with Mitral Valve Repair in Bangladesh: A Comparison
Keywords:Mechanical valve, Mitral valve repair, Aortic valve replacement, Rheumatic heart disease, Bangladesh.
Background: Although all mitral valves are not repairable, most non rheumatic valves and a substantial proportion of rheumatic valves are amenable to repair. Repair preserves the normal valvular tissue, so the left ventricular function is well maintained post-operatively. Combined aortic and mitral valve surgery is associated with increased mortality and morbidity. Several studies have shown the superiority of DVR (Double valve replacement) in this entity to prevent reoperation. Some other data suggested superiority of aortic valve replacement combined with mitral valve repair in double valve disease. No study had been done over Bangladeshi population. Our aim was to compare the short-term outcome of mitral valve repair and aortic valve replacement with double valve replacement.
Methods: It was a prospective non-randomized observational study took place in the Department of Cardiac Surgery of National Institute of Cardiovascular Disease. In this study post-operative result of double valve replacement was compared with aortic valve replacement and mitral valve repair. Total 60 patients under went aortic valve replacement with either mitral valve replacement (n=30) marked as group A or (n=30) repair marked as Group B.
Results: Aortic cross clamp time and cardiopulmonary bypass time was higher in group B than group A but it was well tolerated without any short-term measurable consequences. Required inotrope support was 49.8±2.3 hours in group B and 87.2±3.5 hours in group A (p<0.05). Duration of ICU stay were 91.1±3.2 hours in group A and 60.3±2.9 hours in group B (p<0.05). Development of postoperative low output syndrome was significantly higher (23.33%) in group A versus 3.33% in group B. Patients of group A suffered more from CHF in the follow up period than the group B. But the result was statistically insignificant. There was an early post-operative fall of ejection fraction in both groups but it was recovered after 3 months. Post-operative thromboembolism was 13.79% in group A and 3.33% in group B. There was no early death in repair group though total three (10%) cases died after DVR. There was no valve failure, re-stenosis or regurgitation in any group in this limited follow up period. Higher dose of warfarin was required in group A to maintain INR. Consequently, post-operative major bleeding occurred in 24.14% patients of group A. On the contrary, no patient of repair group suffered from this catastrophe.
Conclusion: This study reveals that the result of mitral valve repair with aortic valve replacement is equally comparable or in some cases superior to that of double valve replacement. Therefore, in feasible cases, mitral valve repair should be attempted who need concomitant aortic valve replacement.
Cardiovasc. j. 2021; 13(2): 164-171