Outcome And Predictors Of Early Complications Of Mitral Valve Replacement In A Centre Serving Low Socioeconomic Community

Background Mitral valve replacement (MVR) surgeries traditionally carry significant risks, due to technical complexity and difficulty to supervise the procedure. The mismatch between patient load and hospital resources in populous countries raises concerns about patient’s safety and training in mitral valve surgery. We evaluated the outcomes of MVR in a tertiary hospital serving a large sector of low socioeconomic populations, in the context of surgical education and risk stratification. Methods A retrospective analysis of preoperative, perioperative and postoperative clinical data collected prospectively of all MVR operations (n=100) performed by residents and consultants at a single academic institution between January2011and January2012. Results There were38(38.0%) male and62(62%) female patients of mean age46.7±12.4years (17-70years). Mitral valve diseases were, mitral regurgitation61(61%) and mitral valve stenosis39(39%). Co morbidities included mild-moderate pulmonary hypertension (n=81), mild-moderate tricuspid regurgitation (n=54), atrial fibrillation (n=43), mild aortic regurgitation (n=28), hepatitis B viral infection (n=35), elevated plasma liver enzymes (n=29), bacterial infection (n=28), diabetes (n=15), malnutrition (n=21), hypertension (n=14), coronary artery disease (n=6), stroke (n=5), left atrial thrombus (n=10), elevated plasma creatinine (n=7), and chronic obstructive pulmonary disease (n=3). Major postoperative morbidities included pulmonary dysfunction (n=78), prolonged ventilation time>350min.(n=43%) and cardiac arrhythmias (n=39). There were5in-hospital deaths. Mean length of postoperative hospital stay was13.0±6.7days.Age, atrial fibrillation, HBV infection, operation time, cross clamp time and neurologic deficit were identified as independent predictors of early adverse outcomes Conclusions We have shown in this initial study that excellent outcomes and training in mitral valve replacement surgery can be achieved in centres serving low socioeconomic communities, if patient’s co morbidities, and work system factors are strictly attended to.