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Risk factors for posterior ventricular rupture after mitral valve replacement: results of 2560 patients

Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

Received 16 January 2008; received in revised form 4 June 2008; accepted 9 June 2008.

^_* Corresponding author. Address: 66 Ada, Kardelen 3/3, No: 42, Atasehir 34758, Kadikoy, Istanbul, Turkey. Tel.: +90 2164556800; fax: +90 2163379719. (Email: onursokullu{at}gmail.com).

Objective: Posterior ventricular rupture is a rare and fatal complication of mitral valve surgery. This study is designed to define the risk factors for left ventricular rupture after mitral valve replacement and, especially, to find out if posterior leaflet preservation is protective for posterior ventricular rupture. Methods: Between January 1996 and March 2007, 2560 patients underwent mitral valve replacement operation in our hospital. Risk factors for posterior ventricular rupture were studied with ² and logistic regression analysis. Results: The surgery was complicated with posterior ventricular rupture in 23 (0.8%) of 2560 patients. Nineteen patients (82.6%) were female, four patients (17.4%) were male. Mean age of the patients in this group was 60 ± 10. Mortality rate of the patients with posterior ventricular rupture was 86% (20 patients). Twelve patients with posterior ventricular rupture were at the age of 60 and older. Age of 60 and above was found as a highly significant risk factor for posterior ventricular rupture (OR 4.53, 95% CI 1.98–10.38, p < 0.001). Posterior leaflet was preserved in 513 patients (20%) and posterior ventricular rupture did not occur in these patients. Resection of posterior leaflet was also found as a highly significant risk factor (p = 0.008) for posterior ventricular rupture. Reoperation was performed in 372 patients and posterior ventricular rupture occurred in 7 of them. Reoperation was also found as a significant risk factor (OR 2.563, 95% CI 1.03–6.34, p = 0.042) for posterior ventricular rupture. Conclusions: Extreme annular traction and aggressive decalcification should be avoided during mitral valve resection. Posterior leaflet of the mitral valve should be preserved, especially in the older age group to prevent posterior ventricular rupture.

Key Words: Mitral valve replacement • Posterior ventricular rupture • Posterior leaflet preservation