Mechanical valve obstruction: Re-replace or not.

Background: Failure of mechanical prothesis after mechanical valve replacement is a dreadful complication. Pannus and thrombosis are common causes of dysfunction. Different strategic plans for management are available but current approach still needs more evidence. Methods: Retrospective study analysis data of patients operated secondary to mechanical valve obstruction (MVO) from July 2014 to December 2019. Preoperative, operative and post operative are collected and analyzed. Results: 27 patients were operated secondary to MVO. Mean age was 31±12 years. Majority of patients were female 15 (55.5 %) and most of patients in NYHA class III. TTE data showed persevered EF (50 ± 11). MVO differ according to obstructed valve, 15 patients with mitral valve thrombus, and 5 of them thrombus and pannus. In aortic valve obstruction, 12 patients were with pannus and 3 of them with thrombus. The commonest preoperative rhythm was sinus rhythm in 17 patients while AF in 10 patients. Mean bypass time was 117 ± 11 per/min while aortic cross clamp was 99 ± 12 per/min. Mitral valve replacement was done in 12 patients and, valve thrombectomy in 5 patients. In Aortic valve obstruction, 9 valve replacement were done and 3 excisions of the pannus. In the present study, the total bleeding was 635 ± 325 ml, and no cases re-explored. One case needed permeant pacing. Total ICU stay was 43 ± 12 hours while total hospital stay was 9.07 ± 1.5 days. Mortality was 2 patients; one patient was early secondary to NYHA status and acute heart failure. The 2 nd was late secondary to endocarditis. Early and mid-term follow up showed no pannus formation or reintervention with mean follow up period up to 36 months. Conclusions: MVO is serious and life-threatening complications. Urgent intervention is the clue. Conservative or surgical approach should be directed for each patient. Thrombolysis has limited role and restricted indications and should directed to critically ill and high-risk patient, while open thrombectomy and pannus excision has good early and mid-term outcome but still lack long term outcome and more evidence still needed. Surgery is the definitive treatment with documented good long-term outcome. [ABSTRACT FROM AUTHOR]