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Comparison of the Mortality Rates of Surgical Techniques for Correcting Atrioventricular Disjunction

Marcelo Luiz Peixoto Sobral, Elcio Pires Junior and Marcelo Luiz Peixoto

Objective: A left ventricular rupture is a rare but lethal complication of surgical mitral valve replacement. We compared the mortality rates of two different surgical techniques for the correction of atrioventricular disjunction.

Methods: From January 2005 to January 2012, 720 patients underwent mitral valve replacement at our institution. Two different surgical techniques were used for the correction of atrioventricular disjunction. The techniques were: in group I, the mitral annulus was fixed with bovine pericardial strips; in group II, a 'patch' of bovine pericardium was sutured; the patch extended from the base of the lateral and medial papillary muscle, covered the posterior wall of the left ventricle, went through the posterior mitral annulus, and ended in the posterior wall of the left atrium adjacent to the mitral ring.

Results: Atrioventricular disjunction occurred in 10 (1.39%) of 720 patients, out of which the group I technique was used in 6 (60%) patients, and the group II technique in 4 (40%) patients. The mortality rate for the group I technique was 100% (6 patients) with 5 deaths in the operating room and 1 death from postoperative cardiogenic shock. For the group II technique, the mortality rate was 25% (1 patient) and the death was associated with late pulmonary sepsis.

Conclusion: The group II technique showed a lower mortality, and was more efficient than the group I technique.