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

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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Infective endocarditis and outcomes of mitral valve replacement

European Journal of Clinical Investigation ◽

10.1111/eci.13577 ◽

2021 ◽

Author(s):

Vesa Anttila ◽

Markus Malmberg ◽

Jarmo Gunn ◽

Päivi Rautava ◽

Ville Kytö

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement

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Mitral valve replacement after transcatheter aortic valve implantation in a patient with rheumatic heart disease and prior Ross procedure: a case report

The Egyptian Heart Journal ◽

10.1186/s43044-019-0030-2 ◽

2019 ◽

Vol 71 (1) ◽

Author(s):

Khaled D. Algarni ◽

Amr A. Arafat

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Ross Procedure ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Reoperations are required frequently after the Ross procedure in rheumatic patients. The use of transcatheter aortic valve implantation (TAVI) in those patients could decrease the risk of future open procedure; however, the outcome may be affected by the concomitant mitral valve disease, and subsequent mitral reoperation may distort the implanted aortic valve. Case presentation We present a female patient who had a beating mitral valve replacement after valve-in-valve TAVI in a patient with prior Ross procedure. Weaning from cardiopulmonary bypass was difficult, and the patient needed extra-cardiac membrane oxygenation (ECMO) and intra-aortic balloon pump because of right ventricular dysfunction. The right ventricular dysfunction could be due to the concomitant coronary artery disease or air embolism during the beating mitral valve surgery. Recovery was gradual, and the patient was discharged after 33 days. Pre-discharge echocardiography showed a maximum gradient of 9 mmHg on the aortic valve and mild paravalvular leak. Conclusions Mitral valve replacement in a patient with prior TAVI and the Ross procedure was feasible; it decreased the operative risk and did not distort the implanted aortic valve.

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Infective Endocarditis After Surgical Aortic or Mitral Valve Replacement: A Nationwide Population-Based Study

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2021.12.027 ◽

2021 ◽

Author(s):

Hsiu-An Lee ◽

Victor Chien-Chia Wu ◽

Yi-Shin Chan ◽

Yu-Ting Cheng ◽

Jen-Kuang Lee ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Population Based ◽

Population Based Study

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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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