Left ventricular rupture after mitral valve replacement.

BACKGROUND

What are the immediate and long term outcomes of patients who had rupture of the left ventricle after mitral valve replacement?

EXPERIMENTAL

DESIGN

A retrospective study with a 20-year follow-up.

SETTING

Experience in a single tertiary referral cardiothoracic surgery hospital.

PARTICIPANTS

20 out of 3105 patients that received mitral valve replacement.

INTERVENTION: All these 20 patients received re-exploration for a trial of repair of left ventricular rupture either by an internal or an external or a combined repair.

MEASURES: Operative mortality and long term outcome of the survivals.

RESULTS

Most patients (16.80%) were female and had rheumatic mitral valve disease. The mean age of the patients was 58.1 years. All patients underwent attempted repair, usually by removal of the prosthesis and reconstitution of the ventricle from within the left atrium (75%). Thirteen (65%) patients died. Two late deaths were of unrelated cause. One surviving patient developed a late ventricular false aneurysm but did not undergo repeat surgery. One patient developed severe mitral regurgitation due to tissue failure of the bioprosthesis 12 years after surgery and she underwent a successful reoperation.

CONCLUSIONS

We believe that all patients should be placed back on cardiopulmonary bypass for an internal repair. The long term outcome of the survivals is satisfactory.