Acute Prosthetic Valve Dysfunction (Redo valve Surgery)

Background: Obstructive prosthetic valve dysfunction (OPVD) is a rare but serious complication, warranting surgery in most cases. Objective: aim of study was to compare the incidence, treatment and results of mechanical prosthetic valve thrombosis/pannus formation requiring redo-surgery in an Iranian and a Hungarian institute during the last decade. Methods: Number of patients, male/female ratio and mean age of Iranian and Hungarian groups were 19 vs.24, 8/11 vs.10/14 (ns) and 55 vs. 62 year (p<0, 05) respectively. Pannus/thrombus removal was performed in 14 cases (4 aortic, 8 mitral and in 2 patients mitral + tricuspid), prosthetic valve replacement in 5 cases (1 aortic, 3 mitral and 1 tricuspid position) in the Iranian group. In the Hungarian center thrombosed valve was cleared away in 3 patients (1 aortic, 1 mitral and 1 in case from both of them), while prosthetic valve implantation was performed in 21 cases (8 aortic, 13 mitral). Results: Reoperation for bleeding occurred in 1 case (5.2%), acute renal failure in 3 patients (15.7%) in the Iranian group. Among the Hungarian patients bleeding, wound infection, PTX, 3rd degree AV block and prolonged respiratory failure developed in 1-1-1-1-1 case respectively (4,2-4,2%). The 30 day mortality of the foreign group was 6.4% (2/19), while of domestic patients was 8.4% (3/24) (ns). According to our study carried out in two distant lands with different culture, the number of redo-operations due to OPVD was similar. The rate of preservation of prosthetic valve was significantly higher in the Iranian group 73,7% vs. 12,5% (p<0,01), however the different surgical strategy does not influenced markedly the rate of complications and mortality. Suspicion of obstructive prosthetic valve dysfunction is an urgent clinical condition, which warrants rapid diagnostic assessment. Treatment strategy will be influenced by prosthesis position, nature and extent of valvular obstruction, by the age and condition of patient.