Beating heart mitral valve replacement in a patient with a previous Bentall operation

Abstract

Today, mitral valve replacement is performed under cardioplegic arrest with cross-clamping of the ascending aorta. In the case reported here, mitral valve replacement was performed with an on-pump beating heart technique without cross-clamping the aorta because of diffuse adhesion around the tube graft. A 36-year-old man had undergone a Bentall operation (aortic root replacement+coronary reimplantation) via median sternotomy because of type I aortic dissection 4 years previously in our cardiac center. He was admitted to the hospital complaining of palpitation and dyspnea on mild exertion. Transthoracic echocardiography study revealed third-degree mitral insufficiency. Mitral valve replacement was carried out through re-median sternotomy with an on-pump beating heart technique without crossclamping the aorta. On-pump beating heart mitral valve replacement without a cross-clamp offers a safe approach when excessive dissection is required to place a crossclamp on the ascending aorta.

Beating heart mitral valve redo surgery in a patient with low ejection fraction and a stuck mitral valve

“…Özellikle aort klemplenip kalp durdurulduğunda KPB'den çıkış daha zor olmaktadır. [2,3] Yeniden mitral cerrahide sağ torakotomi tekniği yapışıklıklar açısından kolay ekspojur sağlamakta ve sternotomiye kıyasla kolaylaşmaktadır. [2] Düşük EF'li hastalarda KPB ile atan kalpte mitral cerrahi, kardiyak arrest sağlanan hastalara oranla daha başarılıdır.…”

Porcelain aorta: a new indication for on-pump beating heart mitral valve replacement

“…[1] As an alternative procedure to conventional mitral valve surgery, beating heart mitral valve surgery without cross-clamping the aorta has been used for valvular operations and reoperations with acceptable clinical results. [2][3][4][5][6][7] Sometimes heavy calcification or severe adhesions around the ascending aorta may not allow us to crossclamp the aorta safely. [4] In this situation, hypothermic fibrillatory arrest or deep hypothermia/total circulatory arrest techniques are mostly performed for mitral valve surgery.…”

“…[2][3][4][5][6][7] Sometimes heavy calcification or severe adhesions around the ascending aorta may not allow us to crossclamp the aorta safely. [4] In this situation, hypothermic fibrillatory arrest or deep hypothermia/total circulatory arrest techniques are mostly performed for mitral valve surgery. [8] In this case, because of the porcelain aorta of the patient, beating heart MVR under normothermic CPB via femoral access without cross-clamping the aorta was the other choice for protecting the aorta.…”

“…A similar technique was described in the literature for cases of redo valve surgery, especially with the open coronary grafts or poor ventricles associated with valvular diseases. [2][3][4][5][6][7] On-pump beating heart mitral valve replacement without cross-clamping along with cannulating the aorta offers a safe approach for the untouched porcelain aorta.…”

Beating-Heart Valve Surgery: A Systematic Review

“…The case reports and series fall into three categories: beating-heart valve surgery in high risk cases (e.g. post infarct VSDs), [23][24][25][26][27][28][29] the use of continuous perfusion to perform valve surgery after previous surgery especially in the presence of patent grafts, which decreases the risk of dissecting and injuring them, [30][31][32][33][34][35][36][37][38][39] and finally the reports by Dr Salerno and his colleagues from Miami introducing the principles of simultaneous antegrade/retrograde warm blood perfusion. [40][41][42][43][44] All reported satisfactory outcomes.…”