A Retrospective Study -survival And Predictors Of Minimally Invasive Mitral Valve Replacement In Rheumatic Population.:

Author Block: Akshaya Singh, Kumaran Mangalam, Deep jakasaniya. 
Narayana institute of cardiac Sciences, Bangalore, India 

Abstract:
BACKGROUND: To analyze Immediate (30 day) and Early ( 9 month ) survival patterns following MIMVR in Rheumatic population.To assess the impact of aortic cross-clamp time on: 1) Duration of mechanical ventilation (hours). 2) Duration of hospital stay (days). METHODS: This is a retrospective observational study conducted on patients with rheumatic heart disease who underwent minimally invasive mitral valve replacement. Data were extracted from electronic medical records. Kaplan-Meier survival analysis used to evaluate survival patterns, stratified by age, gender, and BMI. Log-rank tests were used to compare survival patterns.Linear regression analysis used to identify predictors of aortic cross-clamp time.
RESULTS: This study analyzed demographic, clinical, and procedural characteristics of 88 patients undergoing surgical intervention. The mean age was 44.2 years (SD: 11.8), Descriptive statistics revealed a mean BMI of 23.4 (SD: 3.88), and the average ICU stay was 3.29 days (SD: 3.13). The mean hospital stay was 11.0 days (SD: 3.51), and the average ventilation duration was 28.6 hours (SD: 63.6). Immediate (30day mortality) is 0% and early mortality( 9 month) is 5%. Key predictors of aortic cross-clamp time (mean: 98.2 minutes, SD: 44.7) included ventilation duration (positive), hospital stay (positive), and ejection fraction (negative). A positive association was found between duration of ventilation , hospital stay and aortic cross clamp time. This suggests that longer periods of ventilation and hospital stay were associated with longer cross-clamp times( p<.05). Duration of Ventilation (hours) Estimate: 0.1669, p = 0.02 ,Each additional hour of ventilation is associated with a significant increase of 0.1669 minutes in cross-clamp time. Hospital Stay (days): Estimate: 6.2341, p < 0.001 Longer hospital stays are strongly associated with increased cross-clamp time, with each additional day adding approximately 6.23 minutes. While the Kaplan-Meier survival analysis suggests some differences in survival patterns between males and females, age group (<45,>=45), BMI group (underwright, normal, obese, overweight) the log-rank p-value 0.98,0.078,0.16 (all are >0.05) respectively indicates that these differences are not statistically significant
CONCLUSIONS:Minimally invasive MVR in rheumatic population can be performed safely and effectively with minimal complications. The Immediate and early outcomes in these patients are acceptable. Aortic cross clamp time showed significant impact on hospital stay.