title: Redo Mitral Valve Replacement for Prosthetic Valve Thrombosis: Single Center Experience.
abstract: BACKGROUND
  Prosthetic Valve Thrombosis (PVT) remains a significant cause of morbidity and mortality after valve replacement. Although surgical treatment is usually preferred as life-saving in cases of obstructive PVT, optimal treatment is yet to be decided.
  
  
  OBJECTIVE
  To evaluate risk factors and outcome of the patients undergoing redo mitral valve surgery for acute PVT.
  
  
  METHODS
  Between January 2012 and February 2015, 65 patients underwent redo surgery for obstructive PVT of mitral valve in Department of Cardiothoracic Surgery, UN Mehta Institute of Cardiology & Research Centre. Patients having acute PVT of aortic valve or combined aortic and mitral valve were excluded. Pre-operative, intra-operative and post-operative factors affecting the outcome as well as follow-up data were measured.
  
  
  RESULTS
  There were total 65 patients, 17 males and 48 females. Most common presenting symptom was dyspnea (100%), followed by palpitation (57.88%) and fatigue (29.45%). Total mortality was 29.2% (19/65). Mortality rate was significantly higher (16/35, 46%) in patients with direct surgery (Group-2) as compared to those with failed thrombolysis (3/30, 10%) (Group-1). Mortality was also significantly higher in patients presented with New York Heart Association (NYHA) III/IV class as compared to those presented with NYHA I/II class (p=0.02). All survived patients are NYHA Class I-II in follow-up with mean follow-up period was 24 ± 9 months.
  
  
  CONCLUSIONS
  PVT still remains a challenging problem in a post-operative patient with a high mortality independent of treatment modality. Though life-saving, the surgical management of this condition still carries a high risk in haemodynamically unstable and in NYHA class III/IV patients.
authors.affiliation: Professor, Department of Cardiothoracic and Vascular Surgery, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India .
authors.forename: Jignesh
authors.initials: J
authors.lastname: Kothari
authors.affiliation: Assistant Professor, Department of Cardiothoracic and Vascular Surgery, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India .
authors.forename: Kartik
authors.initials: K
authors.lastname: Patel
authors.affiliation: Resident, Department of Cardiothoracic and Vascular Surgery, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India .
authors.forename: Bhavin
authors.initials: B
authors.lastname: Brahmbhatt
authors.affiliation: Resident, Department of Cardiothoracic and Vascular Surgery, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India .
authors.forename: Kinnaresh
authors.initials: K
authors.lastname: Baria
authors.affiliation: Resident, Department of Cardiothoracic and Vascular Surgery, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India .
authors.forename: Malkesh
authors.initials: M
authors.lastname: Talsaria
authors.affiliation: Research Assistant, Department of Research, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India .
authors.forename: Sanjay
authors.initials: S
authors.lastname: Patel
authors.affiliation: Perfusionist, Department of Perfusion, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India .
authors.forename: Sandeep
authors.initials: S
authors.lastname: Tailor
keywords: Heart valve; Prosthetic; Redo