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We analyzed patient characteristics and IMHA management by reoperations after mitral valve surgery.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We collected medical records from mitral valve patients requiring reoperation due to IMHA. Inclusion criteria: hemoglobin &lt;\u2009100\u2009g\/L; positive hemolysis tests and echocardiography results; and exclusion of other hemolysis causes.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Data from 25 IMHA cases included 10 (40%) early onset (1.3 (0.3,3.0) months) and 15 (60%) late onset (120 (24,204) months) cases. Early IMHA etiologies included surgical defects (6, 60%), uncontrolled infection (3, 30%) and Bechet\u2019s disease (1, 10%). Late IMHA etiologies included degeneration (13, 87%), new infection (1, 7%) and trauma (1, 7%). There were more mechanical valves (15, 88%) than bio-valves (2, 12%); the main valvular dysfunction was paravalvular leak (16, 64%). IMHA manifestations included jaundice (18, 72%), dark urine (21, 84%), heart failure (16, 64%), acute kidney injury (11, 44%), hepatomegaly (15, 60%), splenomegaly (15, 60%) and pancreatitis (1, 4%). Laboratory results showed decreased hemoglobin (70\u2009\u00b1\u200914\u2009g\/L) and increased bilirubin (72\u2009\u00b1\u200957\u2009\u03bcmol\/L), lactate dehydrogenase (2607\u2009\u00b1\u20092142\u2009IU\/L) and creatinine (136\u2009\u00b1\u2009101\u2009\u03bcmol\/L) levels. Creatinine level negatively correlated with hemoglobin level (B\u2009=\u2009-3.33, S.E. B\u2009=\u20091.31, Exp(B)\u2009=\u2009368.15, <jats:italic>P<\/jats:italic>\u00a0=\u20090.018). Preoperative medications included iron supplements (20, 80%), erythropoietin (16, 64%) and beta-blocker (22, 88%). Two patients died of cardiac causes before reoperation. The other 23 underwent reoperation with long surgical times (aortic cross clamp 124\u2009\u00b1\u00a050\u2009min, cardiopulmonary bypass 182\u2009\u00b1\u00a069\u2009min) and blood transfusions (red blood cells 6 (6, 8) units, plasma 600 (400,800) ml, platelet 1(0,2) units). Postoperative complications included cardiac dysfunction (5, 22%), arrhythmia (10, 43%), sepsis (6, 26%), pulmonary infection (5, 22%), gastrointestinal bleeding (3, 13%), cerebral hemorrhage (2, 9%), chronic renal dysfunction (1, 4%) and surgical hemorrhage (1, 4%). Five (33%) patients died after reoperation from cardiac dysfunction (3, 60%), septic shock (1, 20%) and self-discharge (1, 20%).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>IMHA induces severe multi-organ dysfunction, contributing to high mortality. Perioperative management should focus on etiological treatment, organ protection, and blood management.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12872-020-01382-8","type":"journal-article","created":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T21:04:08Z","timestamp":1583269448000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Intractable mechanical hemolytic anemia complicating mitral valve surgery: a case series study"],"prefix":"10.1186","volume":"20","author":[{"given":"Jin","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanlin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongyang","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuelun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaicheng","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hushan","family":"Ao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5531-6721","authenticated-orcid":false,"given":"Chunhua","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,3,3]]},"reference":[{"issue":"25","key":"1382_CR1","doi-asserted-by":"publisher","first-page":"e1159","DOI":"10.1161\/CIR.0000000000000503","volume":"135","author":"RA Nishimura","year":"2017","unstructured":"Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, et al. 2017 AHA\/ACC focused update of the 2014 AHA\/ACC guideline for the Management of Patients with Valvular Heart Disease: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines. 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