Patient Prosthesis Mismatch in Double Valve Replacement - A Retrospective Study at a Tertiary Care Center in Bangalore

2021 ◽  
Vol 8 (30) ◽  
pp. 2768-2772
Author(s):  
Bharathguru N ◽  
Divya Mallikarjun ◽  
Shreedhar S. Joshi ◽  
Shilpa Suresh ◽  
Giridhar Kamalapurkar
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Tertiary Care ◽  
Effective Orifice Area ◽  
Valve Prosthesis ◽  
Care Hospital ◽  
Double Valve Replacement ◽  
Mitral Position ◽  
Patient Prosthesis Mismatch ◽  
Rheumatic Heart

BACKGROUND Valve replacement has become the mainstay of management for rheumatic heart diseases. However, an important and frequent complication of valve replacement is patient prosthesis mismatch (PPM). The present study was undertaken to evaluate a single institution experience on the clinical pattern and presentation of PPM, and the outcomes of double valve replacement surgery. METHODS This retrospective, regional study was carried out among 316 consecutive patients who underwent concomitant aortic and mitral valve surgery (with or without tricuspid annuloplasty) in this tertiary care hospital. Particulars regarding the clinical profile and procedure details (valve types and sizes and priority of surgery) of these patients were documented from the medical records. RESULTS In this institute, the valves used were predominantly mechanical (92.6 %) when compared to bioprosthesis in 7.4 % (47/632 valves - 23 mitral position and 24 in aortic position). The most common sizes used in the aortic and mitral position were 21 mm & 27 mm respectively. In spite of the seemingly lower sizes used in the patients undergoing double valve replacement (DVR) the incidence of PPM is less owing to the fact that the population under study had a lower body surface area (BSA) and body mass index (BMI) - 1.17 ± 0.3 & 19.86 ± 3.9 respectively. CONCLUSIONS It may be emphasized that if the valve size required to be implanted is derived based on the patient’s BSA and indexed effective orifice area, the incidence of patient prosthesis mismatch can be minimized drastically and with it the in-hospital mortality and morbidity. KEYWORDS Aortic Stenosis, Double Valve Replacement, Mitral Valve, Prosthesis, Rheumatic Heart Disease

scholarly journals Use of del nido cardioplegia versus St. thomas solution 2 in adult mitral valve replacement surgery at a tertiary care hospital in Kolkata, India

2020 ◽  
Vol 8 (5) ◽  
pp. 1654
Author(s):  
Swarnendu Datta ◽  
Ushnish Chakrabarty ◽  
Tanmoy Podder ◽  
Plaban Mukherjee
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Tertiary Care ◽  
Care Hospital ◽  
Replacement Surgery ◽  
Cross Clamp Time ◽  
Patient Profiles ◽  
Repeated Dosing ◽  
Mean Time

Background: del Nido cardioplegia has been historically used in paediatric cardiac surgery. However it’s use in adults has also been documented. It has the advantage of 90 minutes of cardiac inactivity over St. Thomas solution no.-2, which requires repeated dosing at 20 minutes interval. Aim of this study to find out whether del Nido cardioplegia with longer duration of arrest is advantageous over St. Thomas solution no. 2 in adult mitral valve replacement.Methods: Total 60 patients of severe mixed mitral valve disease of comparable patient profiles, underwent mitral valve replacement with preservation of anterolateral and posteromedial chordae. Half the patients received del Nido cardioplegia and other half received St. Thomas solution no 2. (ST-2). The two groups were compared.Results: del Nido group had lesser CPB time (70.73±12.15min) as compared to ST-2 group (81.76±20.03min) with  p=0.01 ; lesser Cross clamp time (del Nido- 68.8±10.64min; ST-2- 75.83±14.00min) with p=0.02; lesser time taken to arrest heart  (del Nido- 21.58±13.37 sec; ST-2- 25.26±5.27 sec) with p=0.04 & lesser time taken for normal ECG activity to manifest after release of cross clamp (del Nido- 19.86±6.10 min; ST-2- 31.03±5.28min) with p=0.02. All other parameters did not reach statistical significance.Conclusions: del Nido cardioplegia group of patients required significantly less CPB time; Cross-clamp time; Mean time taken to arrest the heart; as well as that taken to manifest normal ECG morphology when compared to ST-2 group.

Incidence and predictors of mismatch after mechanical mitral valve replacement

2019 ◽  
Vol 27 (7) ◽  
pp. 535-541
Author(s):  
Ashraf AH El Midany ◽  
Ezzeldin A Mostafa ◽  
Tamer Hikal ◽  
Mostafa G Elbarbary ◽  
Ayman Doghish ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Effective Orifice Area ◽  
Orifice Area ◽  
Patient Prosthesis Mismatch

Background Patient-prosthesis mismatch after mitral valve replacement has an unfavorable postoperative hemodynamic outcome, which underlines the importance of identifying and preventing prosthesis- and patient-related risk factors. This study was conducted to determine the incidence and identify possible predictors of patient-prosthesis mismatch. Methods A prospective study was conducted on 715 patients with a mean age of 42 ± 11 years who underwent mechanical mitral valve replacement between 2013 and 2017. The effective orifice area of the prostheses was estimated by the continuity equation, and a mismatch was defined as an effective orifice area index ≤1.2 cm2·m−2. The mean clinical and echocardiographic follow-up was 26.74 ± 11.58 months. Multivariate regression analysis was performed to identify predictors of patient-prosthesis mismatch. Results Patient-prosthesis mismatch was detected in 382 (53.4%) patients. A small mechanical prosthesis (<27 mm) was inserted in 54.3%. Mortality during follow-up was 9% (65 patients). Patient-prosthesis mismatch was identified in patients with preoperative rheumatic mitral valve pathology, associated tricuspid regurgitation, higher New York Heart Association class, preoperative atrial fibrillation, mitral stenosis, and small preoperative left ventricular dimensions. Multivariate analysis identified mitral stenosis, preoperative atrial fibrillation, and small postoperative left ventricular end-diastolic dimension as risk factors for patient-prosthesis mismatch. Conclusion Patient-prosthesis mismatch is a common sequela after mechanical mitral valve replacement. Identification of predictors of patient-prosthesis mismatch can help so that a preoperative strategy can be implemented to avoid its occurrence.

Abstract 2287: Prosthesis-Patient Mismatch is an Independent Predictor of Short-Term Mortality Following Mitral Valve Replacement

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Julien Magne ◽  
Patrick Mathieu ◽  
Jean G Dumesnil ◽  
Eric Charbonneau ◽  
Philippe Pibarot
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Operative Mortality ◽  
Independent Predictor ◽  
Effective Orifice Area ◽  
Term Survival ◽  
Short Term Mortality ◽  
Clinically Significant ◽  
Cabg Patients

Recent studies have shown that prosthesis-patient mismatch (PPM) is associated with an increased incidence of pulmonary hypertension and congestive heart failure and with reduced long-term survival following mitral valve replacement (MVR). The objective of this study was to examine the effect of PPM on operative mortality following MVR. The indexed valve effective orifice area (EOA) was estimated for each type and size of prosthesis being implanted in 1049 consecutive patients undergoing MVR±CABG and used to define PPM as not clinically significant if >1.2 cm 2 /m 2 , as moderate if >0.9 cm 2 /m 2 and ≤1.2 cm 2 /m 2 and as severe if ≤0.9 cm 2 /m 2 . Moderate PPM was present in 56% of patients and severe PPM in 12%. The overall operative mortality (OM) was 7% (n=73) and 84% were from cardiac causes (n=61, 6% of the whole cohort). Patients with severe PPM had higher overall OM (14%, p=0.0003) as well as operative cardiac-related death (CRD) (12%, p=0.007) than patients with moderate (OM: 6%, CRD: 5%) or nonsignificant PPM (OM: 6%, CRD: 4%). On multivariate analysis, severe PPM was an independent predictor of overall OM (Odds-ratio [OR]= 2.6 [95% confidence interval (CI): 1.3– 4.8], p=0.0045) and of operative CRD (OR= 2.3 [95%CI: 1.1– 4.4], p=0.02). Among the subset of 703 patients undergoing isolated MVR (i.e. without concomitant CABG), patients with severe PPM also had higher overall OM (12%, p=0.0025) than patients with moderate (4%) or nonsignificant PPM (3%). Mitral PPM was also a powerful independent predictor of both overall OM (OR=4.8, 95%CI: 1.8 –12.1, p=0.0009) and operative CRD (OR=3.2, 95%CI: 1.03– 8.7, p=0.03) in this subset of patients. Severe PPM is a strong independent predictor of both overall operative mortality and cardiac-related death after MVR. Hence, the projected indexed EOA should be systematically calculated at the time of operation prior to prosthesis implantation and an effort should be made to implant prosthesis with a larger EOA in patients who are identified as being at risk of severe PPM

scholarly journals Mitral Valve Replacement in Children and Adolescents with Rheumatic Heart Disease

1976 ◽  
Vol 17 (5) ◽  
pp. 570-579 ◽  
Author(s):  
Stanley JOHN ◽  
Susil MUNSI ◽  
I. P. SUKUMAR ◽  
George CHERIAN
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Children And Adolescents ◽  
Rheumatic Heart Disease ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Rheumatic Heart

scholarly journals Aortic Root Enlargement In Case of Double Valve Replacement

KYAMC Journal ◽  
2020 ◽  
Vol 11 (2) ◽  
pp. 108-110 ◽  
Author(s):  
Mahbub Ahsan ◽  
Md Lutfar Rahman ◽  
ASM Shariful Islam ◽  
Mohammad Arifur Rahman
Keyword(s):  
Heart Disease ◽  
Cardiopulmonary Bypass ◽  
Survival Rate ◽  
Valve Replacement ◽  
Aortic Root ◽  
Double Valve Replacement ◽  
Post Operative Period ◽  
Patient Prosthesis Mismatch ◽  
Small Aortic Root ◽  
Aortic Root Enlargement

Rheumatic valvular heart disease is quite common in Bangladesh. It affects most commonly mitral and aortic valve. As a result of annular fibrosis, aortic root become smaller in some patients. So, if smaller prosthesis is implanted, there is gross patient prosthesis mismatch (PPM), poor LV regression, increase overload, and ultimately low survival rate. Its' to report our experience in aortic root enlargement in case of double valve replacement where a patient of severe mitral stenosis and aortic regurgitation with small aortic annulus requiring aortic root enlargement (ARE).Weaning from Cardiopulmonary bypass (CPB) was uneventful, perioperative and post operative period was satisfactory. Post-operative echocardiography revealed normally functioning prosthesis. In case of small aortic root, aortic root enlargement (ARE) can be safely done by double valve replacement to overcome the prosthetic patient mismatch (PPM). KYAMC Journal Vol. 11, No.-2, July 2020, Page 108-110

scholarly journals A Study of Clinical, Microbiological, and Echocardiographic Profile of Patients of Infective Endocarditis

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Soumik Ghosh ◽  
Ratnakar Sahoo ◽  
Ranjit Kumar Nath ◽  
Nandini Duggal ◽  
Adesh Kumar Gadpayle
Keyword(s):  
Infective Endocarditis ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cross Sectional ◽  
Northern India ◽  
Predominant Symptom ◽  
Prolonged Duration ◽  
Persistent Bacteremia ◽  
Epidemiological Profile ◽  
Rheumatic Heart

Infective endocarditis, a great masquerader, is a clinical entity which may present with a myriad of manifestations. Its changing epidemiological profile has been studied in the previous decades in both the developed and the developing nations. In this study, we strived to uphold the evolving clinical profile and its outcome from a government tertiary care hospital in Northern India. It was a descriptive, cross-sectional, observational study conducted over two years’ period involving 44 patients diagnosed with definite infective endocarditis, according to modified Dukes’ criteria. Demographic, clinical, microbiological, and echocardiographic data were analysed. Mean age of patients was 31 years. Rheumatic heart disease with regurgitant lesions was the commonest risk factor. Dyspnea and fever were the predominant symptom, and pallor and heart failure the commonest sign. Cultures were positive in 52% with Staphylococcus, the major isolate. Transesophageal echocardiography fared better than transthoracic one to define the vegetations. Mortality is reported in 4.5%. Prolonged duration of fever, pallor, hematuria, proteinuria, rheumatoid factor positivity, and large vegetations proved to be poor prognostic variables. Culture positive endocarditis, with persistent bacteremia, had higher incidence of acute renal failure. Right sided endocarditis was frequent in congenital lesions or IV drug user, whereas left sided endocarditis mostly presented with atrial fibrillation.

scholarly journals Study of prevalence of heart disease in antenatal mothers along with fetal and maternal outcome from a tertiary care hospital, Salem, Tamil Nadu, India

2019 ◽  
Vol 8 (12) ◽  
pp. 5027 ◽  
Author(s):  
Subha Sivagami Sengodan ◽  
Shobhika Selvaraj
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Tamil Nadu ◽  
Congenital Heart ◽  
Neonatal Outcome ◽  
Tertiary Care ◽  
Maternal Outcome ◽  
Care Hospital ◽  
Rheumatic Heart

Background: Incidence of pregnancy in women with heart disease is increasing due to the increasing number of women with congenital heart disease. Although most cardiac conditions are well tolerated during pregnancy, there are some conditions that have adverse fetal and maternal outcome. Objective of this study is to study the prevalence of heart disease in antenatal mothers and fetal outcome with obstetric management.Methods: This is a prospective observational study carried out in the Department of Obstetrics and Gynaecology at Government Mohan Kumaramangalam Medical College and Hospital during January 2018 to March 2019 for a period of fifteen months. Authors included 149 antenatal mothers with heart disease and analysed the data using percentage analysis through excel software.Results: Incidence of heart disease in pregnancy was observed to be 1.2%. Rheumatic heart disease being 73.8%, congenital being 22.8% and complete heart block was 3.4%. Among rheumatic heart disease mitral stenosis was the most common lesion. Atrial septal defect was the most common congenital heart disease. The mean gestational age of delivery was 37 to 38 weeks. 58% delivered by vaginal route. Most common neonatal complication was prematurity. Pregnancy and neonatal outcome were favorable.Conclusions: Heart disease complicating pregnancy has increased due to late marriage, obesity, hypertension and diabetes. Early referral, regular follow-up and multi-disciplinary approach with tertiary care back-up will bring a favorable maternal and neonatal outcome in patients with heart disease.

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