ARE THERE PREDICTORS OF POST OPERATIVE OUTCOME IN PATIENTS UNDERGOING MITRAL VALVE REPLACEMENT FOR RHEUMATIC VALVULAR HEART DISEASE?

Abstract

Background: Rheumatic heart disease is the most common cause of valvular heart disease in developing countries. Frequently patients present quite late in their disease course. We sought to determine the predictors of post operative outcome in patients undergoing mitral valve replacement for rheumatic heart disease. Methods: This retrospective study was conducted in Shifa International hospital, Islamabad from February 2003 to December 2006. 34 patients underwent mitral valve replacement due to rheumatic mitral valve disease. All patients had their demographic characteristics, operative details and comprehensive preoperative and post operative echocardiographic parameters recorded. Data was analyzed using SPSS V.13 statistical software. Results: Mean age of the study population was 35.09±10.52 years with female predominance (n =23, 67.6 %). After a mean follow-up of 187.2±17.51 days, the ability of preoperative and postoperative clinical and echocardiographic data to predict outcome and the impact of valve replacement on survival was assessed retrospectively. 30 patients (88.2%) underwent mitral valve Replacement due to underlying isolated rheumatic mitral valve while 4 patients (11.8%) had both mitral and aortic valve replacement. 12 patients (35.3%) had tricuspid valve annuloplasty done during the same operation. There were no perioperative deaths. There were 2 (5.9%) deaths after a mean period of 162±12 days as a result of prosthetic valve thrombosis. Comparison of pre operative and post operative echocardiographic data revealed statistically significant reduction in pulmonary artery systolic pressure in 28 patients (p-value 0.001), reduction in left atrial size in 31 patients (p-value 0.001) and reduction in right ventricular dimensions in 25 patients (p-value 0.001). Actual probability of freedom from ytlve related death, including in-hospital mortality, at cumulative follow up duration of 25.76±17.62 mrn hs was 94.1% irrespective of preoperative echocardiograpgic parameters, mono or bivalvular rep acement and post procedural congestive cardiac failure or thromboembolic events.