Third time mitral valve replacement-lessons learned

Abstract

We report the management of three iatrogenic injuries involving the aortic valve, left circumflex artery, and left ventricular outflow tract, that occurred during a re-operative mitral valve replacement.

Redo mitral valve surgery following prior mitral valve repair

“…Reoperative mitral valve surgery is more complex and is associated with a high incidence of unique surgical complications including annular rupture, left atrial dissection, left ventricular outflow obstruction, and Gerbode defects . Optimal myocardial protection is crucial.…”

Short- and long-term outcomes following redo valvular surgery

“…During redo aortic valve procedures, injuries to the conduction system may necessitate permanent pacemaker implantation. During mitral valve surgery, left atrial dissection and A‐V disruption may occur as well as injuries to the native aortic valve, left circumflex artery, and left ventricular outflow tract . Redo valve surgery may also result in post‐operative myocardial dysfunction because of prolonged aortic cross clamp times.…”

“…During mitral valve surgery, left atrial dissection and A-V disruption may occur as well as injuries to the native aortic valve, left circumflex artery, and left ventricular outflow tract. [28][29][30] Redo valve surgery may also result in post-operative myocardial dysfunction because of prolonged aortic cross clamp times. The use of sutureless valve prostheses may help to expedite these procedures, especially during multi-valve surgery and in those procedures with concomitant coronary artery bypasses.…”

Repeat extracorporeal membrane oxygenation support-Are the results better the second time around?

“…As is the case with all cardiac procedures, a percentage of patients will require a repeat procedure in their lifetime. This is more common in redo valve surgery where reoperative surgery may be performed three or four times with an in‐hospital mortality of 5.8% and a 20‐year survival as high as 60% . As the number of ECMO procedures continue to increase annually, a percentage of these patients may require a repeat ECMO procedure.…”

“…This is more common in redo valve surgery where reoperative surgery may be performed three or four times with an in-hospital mortality of 5.8% and a 20-year survival as high as 60%. 3,4 As the number of ECMO procedures continue to increase annually, a percentage of these patients may require a repeat ECMO procedure. Unfortunately, there is currently little data to determine whether Repeat ECMO Patients (REPs) will have better outcomes the second time around.In this edition of the Journal, Brady and coworkers review the outcomes of REPs and compare them to the overall ECMO population in the Nebraska ECMO Research Database.…”