Iatrogenic left circumflex coronary occlusion following mitral valve replacement surgery: A case report

Abstract

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Circumflex Coronary Artery Injury during Modern Mitral Valve Surgery—A Review of Current Concepts and Perspectives

“…In total, 30-day mortality occurred in 20.2% of documented patients who sustained CX injury during MV surgery from 1967, which improved to 16.7% from reports published between 2011 and 2022. The favorable in-hospital survival outcomes of conservative therapy in partial CX occlusions were recently independently reported by Yavari [ 43 ] and Nasseradine [ 49 ] after attempts at rescue PCI were unsuccessful. However, post-discharge reports on these patients were not available.…”

“…The documented incidence of CX injury secondary to MV surgery varies between 0.15% and 4.0% [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], but various authors suggest that the true incidence is probably significantly higher due to underreporting. Danielson and colleagues [ 1 ] were the first to document 3 patients with CX injury in their series of 178 MV procedures in 1967, followed by Roberts [ 2 ], Morin [ 3 ], Virmani [ ...…”

“…Once suspected, urgent confirmation of CX injury and the rapid identification of the responsible mechanism by TEE and/or coronary angiography are crucial to expedite the appropriate treatment strategy [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Flow-limiting CX injuries diagnosed intraoperatively require emergency revascularization and restoration of distal perfusion by either emergency empiric coronary artery bypass grafting (CABG) of the obtuse marginal branches utilizing saphenous vein [ 6 , 10 , 14 , 15 , 19 , 27 , 31 , 37 , 38 , 48 ], by revising the prosthesis sutures [ ...…”

“…Revascularization by PCI is feasible and preferred in a stable intraoperative setting where CX injury is confirmed to be the result of a partial CX occlusion and where transfer and ischemic reperfusion times are minimal. The inability to cross totally occluded CX injuries with guidewires, stent under-expansion and potential CX rupture are amongst the immediate risks reported with PCI [ 43 , 48 , 49 ]. The recent advances in hybrid theatre technology, which facilitate combined single-stage surgical MV and TC interventions [ 65 ], may decrease CX ischemic reperfusion time by providing the option of rapid on-table coronary angiography and attempts at PCI as an alternative to CABG once the clinical suspicion and mechanism of CX injury is confirmed by TEE ( Figure 5 ).…”

“…Myocardial infarction secondary to circumflex coronary artery (CX) distortion or occlusion during mitral valve (MV) surgery is associated with devastating postoperative morbidity and mortality outcomes [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Despite significant improvements in preoperative risk identification [ 50 , 51 , 52 , 53 , 54 ...…”