Does the mitral valve prosthesis adversely affect the hemodynamic performance of the aortic valve prosthesis in patients with double valve replacement?

We report a case of a 57 year-old woman with Starr- Edwards model 6120 mitral valve replacement and Kay- Shiley bioprosthetic tricuspid valve replacement in 1968 at Niguarda Hospital in Milan. The mitral caged-ball has proved its excellent durability and its good hemodynamic performance in many patients, even if subject to high tendency to thrombosis. In literature there is no evidence of durability of this prosthesis longer than 35 years. Our patient after 39 years from mitral valve replacement lives a happy and fulfilling life (NYHA II), with no evidence of hemolysis, ball variance, symptomatic embolization or major bleeding.

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Late Results of Aortic Valve Replacement with Bjork Shiley Prostheses: A Comparison of Standard Aortic Valve Prosthesis with Reversed Mitral Valve Prosthesis Implanted in Aortic Position

The International Journal of Artificial Organs ◽

10.1177/039139888901201112 ◽

1989 ◽

Vol 12 (11) ◽

pp. 728-732

Author(s):

T.K. Kaul ◽

J.L. Mercer

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Late Results ◽

Valve Prosthesis ◽

Mitral Valve Prosthesis ◽

Group I ◽

Significant Difference ◽

Group Ii

Between 1976 and 1983, 435 patients underwent aortic valve replacement (AVR) with Bjork Shiley prostheses. Standard aortic Bjork Shiley prostheses (ABP) were used in 150 patients (Group I) and a reversed mitral Bjork Shiley prostheses in 285 (MBP in 250 and MBC in 35) patients (Group II). There was no significant difference in the number of the patients with valve calcification or the size of aortic root in the 2 groups. There was no significant difference in the early mortality in these two groups. The total follow up period in Group I was 912 years and 2130 years in Group II. The incidence of major aseptic prosthetic dehiscence and valve occlusion with tissue ingrowth were higher in Group I than in Group II. Reversed Bjork Shiley mitral valve prosthesis was successfully used in aortic position with reduced incidence of valve related complications.

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Transcatheter Aortic Valve Implantation after Previous Mechanical Mitral Valve Replacement: Expanding Indications?

The Heart Surgery Forum ◽

10.1532/hsf98.20101148 ◽

2011 ◽

Vol 14 (3) ◽

pp. 166 ◽

Cited By ~ 16

Author(s):

Carsten J. Beller ◽

Raffi Bekeredjian ◽

Ulrike Krumsdorf ◽

R�diger Leipold ◽

Hugo A. Katus ◽

...

Keyword(s):

High Risk ◽

Mitral Valve ◽

Aortic Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Severe Aortic Stenosis ◽

Valve Prosthesis ◽

Transcatheter Aortic Valve ◽

Mitral Valve Prosthesis ◽

Risk Patients

Background: Cardiac operation for severe aortic stenosis after previous mitral valve replacement is a surgical challenge in older patients with multiple morbidities. Transcatheter aortic valve implantation (TAVI) after previous mechanical mitral valve replacement has been considered a high-risk procedure, owing to possible interference with the mitral valve prosthesis.Methods: Since August 2008, 5 female high-risk patients with severe aortic stenosis and previous mitral valve replacement (mean � SD age, 80 � 5.1 years; logistic EuroSCORE, 39.3% � 20.5%) underwent TAVI with a pericardial xenograft valve that was fixed with a stainless steel, balloon-expandable stent (Edwards Lifesciences SAPIEN). We used a transapical approach in 4 patients and a transfemoral approach in 1 patient. Transesophageal echocardiography and multidetector computed tomography were used for preoperative planning and assessment of operation feasibility. The mean distance between the aortic annulus and the mitral valve prosthesis was 10 � 1 mm (range, 9-11 mm).Results: TAVI was performed successfully in all 5 patients. There was no direct or functional interference with the mechanical mitral valve prostheses. Echocardiography revealed good valve function with no more than mild paravalvular incompetence early in the postoperative period and during routine follow-up. There were no neurologic events. After an initially uneventful course with good aortic valve function at the most recent echocardiography evaluation, however, 2 of the patients died from fulminant pneumonia on postoperative days 4 and 48.Conclusion: TAVI is technically feasible in high-risk patients after previous mechanical mitral valve replacement; however, careful patient selection is mandatory with respect to preoperative clinical status and anatomic dimensions regarding the distance between aortic annulus and mitral valve prosthesis.

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Aortic Valve Prosthesis-Patient Mismatch in a Patient Undergoing Redo Mitral Valve Replacement for Infective Endocarditis

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2018.02.016 ◽

2018 ◽

Vol 32 (6) ◽

pp. 2802-2809 ◽

Cited By ~ 1

Author(s):

Anna Lahori ◽

Jonathan Frogel ◽

John G. Augoustides ◽

Prakash A. Patel ◽

William J. Vernick ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Aortic Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Valve Prosthesis ◽

Aortic Valve Prosthesis

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Transcatheter Aortic Valve Replacement for Inoperable Severe Rheumatic Aortic Stenosis with Prior Mitral Valve Prosthesis

Journal of Structural Heart Disease ◽

10.12945/j.jshd.2017.015.16 ◽

2017 ◽

Vol 3 (4) ◽

pp. 115-118

Author(s):

Imad A. Alhaddad

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Valve Prosthesis ◽

Transcatheter Aortic Valve ◽

Mitral Valve Prosthesis

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Minimally invasive redo aortic valve replacement with a sutureless valve implant

10.1510/mmcts.2021.008 ◽

2021 ◽

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Valve Prosthesis ◽

Mechanical Prosthesis ◽

Invasive Approach ◽

Replacement Procedure ◽

Aortic Valve Prosthesis ◽

Sutureless Valve

Reoperations for a dysfunctional mechanical aortic valve prosthesis are usually performed with a repeat sternotomy. Reopening the chest may be associated with a heart structure tear, bleeding, excessive transfusion, and a possible unfavorable outcome. Experience performing a redo aortic valve replacement with a minimally invasive approach and avoiding lysis of the pericardial adhesions is growing. We describe a redo aortic valve replacement procedure performed because of subvalvular pannus formation in a patient with a mechanical prosthesis. A partial J-shaped hemisternotomy at the 3rd intercostal space was performed; the ascending aorta was exposed and the valve was replaced with a sutureless bioprosthesis. The video tutorial shows the surgical approach, cardiopulmonary bypass solutions, and sutureless valve deployment.

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