Background
Methods
Patient selection
Perioperative management
Data collection
Statistical analysis
Results
Participants
Early IMHA | Late IMHA | Total | |
---|---|---|---|
Demographics | |||
Age (y/o) | 49 ± 14 | 55 ± 10 | 53 ± 12 |
Male (n,%) | 7 (70) | 12 (80) | 19 (76) |
BMI (kg•m2) | 22.60 ± 3.09 | 22.50 ± 3.21 | 22.54 ± 3.16 |
Smoking (n,%) | 1 (10) | 9 (60) | 10 (40) |
Drinking (n,%) | 1 (10) | 5 (33) | 6 (24) |
Comorbidities | |||
Hypertension (n,%) | 3 (30) | 3 (20) | 6 (24) |
Diabetes (n,%) | 2 (20) | 0 (0) | 2 (8) |
Stroke (n,%) | 2 (20) | 1 (7) | 3 (12) |
Atrial fibrillation (n,%) | 0 (0) | 6 (40) | 6 (24) |
CAD (n,%) | 2 (20) | 1 (7) | 3 (12) |
Early IMHA | Late IMHA | Total | |
---|---|---|---|
Primary mitral valve disease | |||
Rheumatic | 2 (20) | 11 (73) | 13 (52) |
Infection | 4 (40) | 1 (7) | 5 (20) |
Others | 4 (40) | 3 (20) | 7 (28) |
First operation | |||
Mitral valve repair | 6 (60) | 2 (13) | 8 (32) |
Mitral valve replacement | 4 (40) | 13 (87) | 17 (68) |
Prosthetic valve type | |||
Bio-valve | 1 (25) | 1 (8) | 2 (12) |
Mechanical valve | 3 (75) | 12 (92) | 15 (88) |
Valve brand | |||
CarboMedics | 2 (50) | 4 (31) | 6 (35) |
Medtronics | 1 (25) | 2 (15) | 3 (18) |
St Jude | 0 (0) | 4 (31) | 4 (24) |
Sorin | 0 (0) | 1 (8) | 1 (6) |
Unknown | 1 (25) | 2 (15) | 3 (18) |
Early IMHA | Late IMHA | Total | |
---|---|---|---|
Onset time after the first mitral valve operation | |||
0–6 months | 10 (100) | 0 (0) | 10 (40) |
6–12 months | 0 (0) | 0 (0) | 0 (0) |
1–10 years | 0 (0) | 7 (47) | 7 (28) |
10–20 years | 0 (0) | 6 (40) | 6 (24) |
20–30 years | 0 (0) | 2 (13) | 2 (8) |
Reoperation etiologies | |||
Surgical defects | 6 (60) | 0 (0) | 6 (24) |
Degeneration | 0 (0) | 13 (87) | 13 (52) |
Infection | 3 (30) | 1 (7) | 4 (16) |
Vasculitis | 1 (10) | 0 (0) | 1 (4) |
Trauma | 0 (0) | 1 (7) | 1 (4) |
Mitral valve dysfunction type | |||
Paravalvular leak | 4 (40) | 12 (80) | 16 (64) |
Open-closure dysfunction | 4 (40) | 3 (20) | 7 (28) |
Perforation | 2 (20) | 0 (0) | 2 (8) |
Paravalvular leakage location (midpoint) | |||
2–3 o’clock | 2 (50) | 4 (33) | 6 (38) |
5–8 o’clock | 2 (50) | 3 (25) | 5 (31) |
10–12 o’clock | 0 (0) | 3 (25) | 3 (19) |
Unknown | 0 (0) | 2 (17) | 2 (13) |
Reoperation | |||
Mitral valve replacement | 8 (80) | 14 (93) | 22 (88) |
Mitral valve repair | 1 (10) | 0 (0) | 1 (4) |
Died before reoperation | 1 (10) | 1 (7) | 2 (8) |
Valve brand | |||
CarboMedics | 2 (25) | 6 (43) | 8 (36) |
Medtronics | 2 (25) | 3 (21) | 5 (23) |
St Jude | 2 (25) | 2 (14) | 4 (18) |
Sorin | 0 (0) | 1 (7) | 1 (5) |
Unknown | 2 (25) | 2 (14) | 4 (18) |
Early IMHA | Late IMHA | Total | |
---|---|---|---|
Symptoms and signs | |||
Jaundice | 6 (60) | 12 (80) | 18 (72) |
Dark Urine | 8 (80) | 13 (87) | 21 (84) |
Heart failure | 3 (30) | 13 (87) | 16 (64) |
Acute kidney injury | 4 (40) | 7 (47) | 11 (44) |
Hepatomegaly | 3 (30) | 12 (80) | 15 (60) |
Splenomegaly | 3 (30) | 12 (80) | 15 (60) |
Laboratory results | |||
Hb (g/L) | 68 ± 14 | 72 ± 16 | 70 ± 14 |
Cr (μmol/L) | 127 ± 95 | 142 ± 121 | 136 ± 101 |
Tbil (μmol/L) | 41 ± 19 | 89 ± 62 | 72 ± 57 |
Dbil (μmol/L) | 13 ± 7 | 18 ± 8 | 16 ± 7 |
LDH (IU/L) | 1623 ± 1009 | 3263 ± 2462 | 2607 ± 2142 |
Mitral valve echo parameters | |||
Flow rate (m/s) | 2.3 ± 0.6 | 2.6 ± 0.4 | 2.5 ± 0.5 |
Peak pressure (mmHg) | 23.3 ± 11.4 | 27.2 ± 9.3 | 25.6 ± 10.3 |
Regurgitation (1+/2+/3+) | 1/3/6 | 1/10/4 | 2/13/10 |
Pre-op transfusion volume | |||
RBC (U) | 1 (0,2) | 5 (2,8) | 2 (1,7) |
Plasma (ml) | 0 (0, 100) | 100 (0,400) | 0 (0,400) |
Pre-op medication | |||
Beta-blocker | 9 (90) | 13 (87) | 22 (88) |
Iron supplements | 8 (80) | 12 (80) | 20 (80) |
Erythropoietin | 6 (60) | 10 (67) | 16 (64) |
Early IMHA | Late IMHA | Total | |
---|---|---|---|
ACC time (min) | 121 ± 61 | 125 ± 45 | 124 ± 50 |
CPB time (min) | 186 ± 69 | 180 ± 69 | 182 ± 69 |
RBC (U) | 8 (5, 8) | 6 (6,10) | 6 (6,8) |
Plasma (ml) | 800 (400, 800) | 600 (400, 700) | 600 (400, 800) |
Platelet (U) | 1 (0,2) | 1 (1,2) | 1 (0,2) |
Urine (ml) | 686 ± 448 | 394 ± 148 | 472 ± 326 |
Epinephrine | 5 (56) | 7 (50) | 12 (52) |
Norepinephrine | 5 (56) | 7 (50) | 12 (52) |
Dopamine | 4 (44) | 7 (50) | 11 (48) |
Dobutamine | 1 (11) | 2 (14) | 3 (13) |
Amiodarone | 5 (56) | 10 (71) | 15 (65) |
Early IMHA | Late IMHA | Total | |
---|---|---|---|
Complications | |||
Low cardiac output | 1 (11) | 4 (29) | 5 (22) |
Arrhythmia | 2 (22) | 8 (57) | 10 (43) |
Septic shock | 1 (11) | 5 (36) | 6 (26) |
Pulmonary infection | 2 (22) | 3 (21) | 5 (22) |
Gastrointestinal bleeding | 0 (0) | 3 (21) | 3 (13) |
Cerebral hemorrhage | 1 (11) | 1 (7) | 2 (9) |
Chronic renal dysfunction | 0 (0) | 1 (7) | 1 (4) |
Surgical hemorrhage | 0 (0) | 1 (7) | 1 (4) |
Tracheotomy | 0 (0) | 2 (14) | 2 (9) |
CRRT | 3 (33) | 7 (50) | 10 (43) |
IABP | 0 (0) | 2 (14) | 2 (9) |
ECMO | 0 (0) | 0 (0) | 0 (0) |
Outcomes | |||
Ventilator (hours) | 35 ± 30 | 413 ± 376 | 259 ± 342 |
Length of ICU stay (d) | 4 ± 2 | 9 ± 6 | 7 ± 5 |
Length of hospital stay (d) | 30 ± 20 | 37 ± 16 | 31 ± 17 |
Mortality (n,%) | 2 (20) | 5 (33) | 7 (28) |