Title : Mitral-aortic-tricuspid valve correction in CPB complicated with small cavity of left ventricle
Abstract:
Aim: To determine significance of patient-prosthesis mismatch (PPM) (indexed effective orifice area < 1,2 cm²/m²) after combined mitral-aortic valve replacement (MAVR) + TV`s plasty (TV) in pts with small cavity of left ventricle (SCLV) (end-diastolic volume (EDV) ≤ 75 ml) during hospital period.
Materials: 1811 adult patients (pts) with MAVR+ TV`s plasty were operated in Institute from 01.01.2009 till 01.01.2024. There were 127 (7,0%) pts with SCLV (mitral-aortic stenoses). There were 48(37,8%) males and 79(62,2%) females. Average age was 53,2+ 7,1. 110 (86,6%) pts belonged to IV NYHA class of heart failure, 17 (13,4%) – to III class. Previous closed mitral comissurotomy was performed in 31 (24,4%) pts, to 7 pts – twice (closed recomissirotomy by closed method). Thromboses of left atrium was marked at 13 (10,2 %) pts, including massive in 3 pts. All operations were performed with cardiopulmonary bypass and moderate hypothermia with crystalloid cardioplegia. Average BSA was 1,87±0,32 m². Following prostheses were implanted: bileaflet (Saint Jude, Carbomedics, On-X, ATS) (n=88) and monodisc as Alcarbon`s type (MIKS, LIKS) (n=39). Following prosthesis sizes were used: 23 mm (n=1), 25 mm (n=74), 26 mm (n=3), 27 mm (n=49).
Results: Hospital mortality (HM) was 5,5% (n=7). It was higher in cases with 27 mm size of implanted prosthesis - 8,2% (n=4/49), than other group - 3,8% (n=3/78) (p <0,01). PPM were marked in 21 (16,5%) pts with BSA >1,75 m² and size of prothesis 25 mm but theren`t influence on HM. Heart failure and PPM were marked in 5 (3,9%) pts with BSA>1,75 m², size of prothesis 25 mm and cavity of LV (EDV≤50 ml). Risk-factors for PPM SCLV`s group of pts on hospital stage were: very small cavity of LV (EDV≤50 ml) especially in pts with BSA>1,75 m², previous operation, pulmonary hypertension (> 90mm Hg), mitral valve calcification 3+, duration of rheumatic disease ≥ 25 years. At the remote period (average 15,3± 1,2 yy) 115(95,8%) pts were followed–up. Survival at 15 year follow- up – 85,1%. EDV was increased at 35,4% at the hospital period. PPM wasn`t marked at remote period.
Conclusion: Pts with SCLV are in group of higher risk for operation and increasing risk of PPM. In these cases implantation of 25 mm prosthesis is expedient, but for pts with EDV EDV≤50 ml BSA>1,75 m² it may lead for significant PPM and heart failure. . Bioprosrhesis cannot be used in cases of critical small cavity of left ventrical.
