title: Risk factors for posterior ventricular rupture after mitral valve replacement: results of 2560 patients.
abstract: OBJECTIVE
  Posterior ventricular rupture is a rare and fatal complication of mitral valve surgery. This study is designed to define the risk factors for left ventricular rupture after mitral valve replacement and, especially, to find out if posterior leaflet preservation is protective for posterior ventricular rupture.
  
  
  METHODS
  Between January 1996 and March 2007, 2560 patients underwent mitral valve replacement operation in our hospital. Risk factors for posterior ventricular rupture were studied with chi(2) and logistic regression analysis.
  
  
  RESULTS
  The surgery was complicated with posterior ventricular rupture in 23 (0.8%) of 2560 patients. Nineteen patients (82.6%) were female, four patients (17.4%) were male. Mean age of the patients in this group was 60+/-10. Mortality rate of the patients with posterior ventricular rupture was 86% (20 patients). Twelve patients with posterior ventricular rupture were at the age of 60 and older. Age of 60 and above was found as a highly significant risk factor for posterior ventricular rupture (OR 4.53, 95% CI 1.98-10.38, p<0.001). Posterior leaflet was preserved in 513 patients (20%) and posterior ventricular rupture did not occur in these patients. Resection of posterior leaflet was also found as a highly significant risk factor (p=0.008) for posterior ventricular rupture. Reoperation was performed in 372 patients and posterior ventricular rupture occurred in 7 of them. Reoperation was also found as a significant risk factor (OR 2.563, 95% CI 1.03-6.34, p=0.042) for posterior ventricular rupture.
  
  
  CONCLUSIONS
  Extreme annular traction and aggressive decalcification should be avoided during mitral valve resection. Posterior leaflet of the mitral valve should be preserved, especially in the older age group to prevent posterior ventricular rupture.
authors.affiliation: Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Hayati
authors.initials: H
authors.lastname: Deniz
authors.forename: Onur
authors.initials: O
authors.lastname: Sokullu
authors.forename: Soner
authors.initials: S
authors.lastname: Sanioglu
authors.forename: Murat
authors.initials: M
authors.lastname: Sargin
authors.forename: Batuhan
authors.initials: B
authors.lastname: Ozay
authors.forename: Umut
authors.initials: U
authors.lastname: Ayoglu
authors.forename: Serap
authors.initials: S
authors.lastname: Aykut Aka
authors.forename: Fuat
authors.initials: F
authors.lastname: Bilgen
mesh_terms: D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D005260:Female; D006341:Heart Rupture / Q000209:etiology*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D055815:Young Adult