[Mitral valve replacement in Réunion Island. Short- and medium-term results].
Mitral valve surgery represents 34.6% of all open heart surgery in our unit. The aim of this study is to assess the early and intermediate term results in a consecutive series of 81 mitral valve replacements (mechanical: 67, bioprosthesis: 14) performed between September 1991 and December 1993. The mean age was 45.7 +/- 15 years (male 26, female 55). Twenty five patients (30.9%) were classified as functional class II of the New York Heart Association classification (NYHA) and 56 (89.1%) as class III or IV. Eight were operated in an emergency. Acute rheumatic fever (49.3%) and bioprosthetic dysfunction were the two main etiologies. Thirty patients (37%) had a history of previous cardiac surgery. Hospital mortality was 13.8% (11 patients). Risk factors associated with high operative mortality were: age, emergency, previous cardiac surgery, atrial fibrillation and tricuspid annuloplasty. All survivors were contacted. Mean follow-up was 30.8 +/- 9 months (range: 3.1-46.4). Five patients had died by the last date of follow-up. Actuarial survival at 1 and 4 years was 86% and 77%, respectively. Late events were mainly 9 episodes of thrombosis, 3 cases of thrombo-embolism and 1 peri-prosthetic leak; five patients were reoperated. The linearized incidence of these events was respectively: 5.1%, 1.7%, 0.5% and 3.4% per patient/year, respectively. There were no complications in case of bioprostheses. Functional improvement was satisfactory and 93% of patients were in NYHA class I or II at the most recent follow-up. Functional results after mitral valve replacement were satisfactory, regardless the type of prosthesis; however valve-related complications are very serious. Conservative mitral surgery is currently our first choice whenever possible.
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Service de Chirurgie Cardio-thoracique et Vasculaire, Centre Hospitaller Départemental Félix Guyon, Saint-Denis (La Réunion).
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D012086:Reoperation; D017508:Reunion; D013927:Thrombosis / Q000209:etiology
Remplacement valvulaire mitral à l'Ile de la Réunion. Résultats à court et moyen terme.