Rheumatic mitral valve surgery in low ejection fraction patients

Abstract

Objective Although, in Mitral valve disease, ischemic heart disease and degenerative etiology have the upper hand in developing countries, rheumatic fever still predominates in developing countries including Egypt. Due to delay presentation some patients had very low EF which made the surgery theoretically risky. Our study aims to emphasize the benefit of surgery in this group of patients. Patients and methods 100 consecutive patients with Inclusion criteria: Rheumatic Mitral valve disease +/- Tricuspid valve disease, aging 18 to 75 with Ejection Fraction< 35% Exclusion criteria: Non rheumatic etiology, associated Ischemic Heart Disease, other valvular lesions, redo cases and age less than 18. Results Mean age 49, 57 males, with mean Ejection Fraction 25%, Aortic Cross Clamp time 26 minutes, all patients were weaned with inotropic support, mean Intensive care unit stay 83.7 hours and hospital stay 11 days. After one year 28% regain normal Ejection Fraction above 50% and 44% are living without anti failure treatment. Conclusion Rheumatic Mitral surgery is safe in low Ejection Fraction, by far aortic cross clamp and myocardial protection is key factor in prognosis.

Keywords

• cardiomyopathy
• mitral stenosis
• mitral valve
• rheumatic