| Abstract [eng] |
Introduction: Hemolytic anemia developing due to residual mitral regurgitation after mitral valve repair is a rare but clinically significant complication. Mechanical intravascular hemolysis develops due to high shear stress caused by the regurgitant blood jet interacting with the annuloplasty ring, suture material, or other structures. Although this complication occurs rarely, its clinical significance is high due to the progression of anemia, the need for red blood cell mass transfusions, and possible repeat interventions. Aim: To perform a 15-year single-center retrospective analysis of mitral valve repair, to determine the frequency of hemolytic anemia developing due to residual mitral regurgitation, to evaluate the treatment outcomes, morbidity, and fatality of these patients, and to compare the obtained results with data presented in the literature. Subjects and methods: The initial sample included all patients (n = 724) who underwent mitral valve repair at VUL Santaros Klinikos from January 1, 2010, to December 31, 2024. The final study group included 8 patients who were diagnosed with hemolytic anemia associated with residual mitral regurgitation in the postoperative period. Patients were selected based on echocardiographically confirmed residual mitral regurgitation and signs of active hemolysis. Results: Over the 15-year period, 8 cases of clinically significant hemolytic anemia after mitral valve repair were identified, accounting for 1.1% of all mitral valve repair procedures performed during the evaluated period. The study group consisted of 6 men and 2 women, and the median patient age was 53.0 years. All patients underwent mitral valve repair with annuloplasty ring implantation during the primary operation, PTFE artificial chordae were used in 6 patients. The median time from the primary operation to the diagnosis of hemolytic anemia was 73.5 days. The median requirement for red blood cell mass from the diagnosis of hemolytic anemia to repeat surgery was 18.5 units. Most patients had grade III residual mitral regurgitation, however, in one patient, clinically significant hemolysis developed with only grade I mitral regurgitation. The most common regurgitant jet mechanism was jet acceleration, identified in 5 patients, jet collision was identified in 3 patients. All patients required repeat intervention: mitral valve replacement was performed in 6 patients, and repeat mitral valve repair in 2 patients. The median follow-up period was 709.5 days. At the last follow-up, 5 patients were alive and 3 had died. Conclusions: Residual mitral valve insufficiency after mitral valve repair, presenting with hemolytic anemia, is a significant clinical factor influencing patient morbidity, the need for repeat interventions, and postoperative outcomes. |
