Mitral valve replacement in patients after aortic valve replacement.

Area of Science:

• Cardiac Surgery
• Thoracic Surgery
• Cardiovascular Research

Background:

• Mitral valve replacement following aortic valve replacement presents significant surgical challenges.
• Existing rigid aortic prostheses impede visualization of the anterior mitral annulus and suture placement.

Purpose of the Study:

• To describe a surgical approach for reoperative mitral valve replacement in patients with prior aortic valve replacement.
• To evaluate the safety and efficacy of this technique in a small patient cohort.

Main Methods:

• Five patients underwent reoperative mitral valve replacement after aortic valve replacement.
• Surgical access included resternotomy in two patients and anterolateral right thoracotomy in three.
• Mitral annular exposure was achieved by anterior leaflet traction before resection, with suture placement preceding leaflet removal.

Main Results:

• All five patients survived the procedure with good outcomes at 2-30 months post-operation.
• One patient experienced prosthetic mitral valve dysfunction (cusp opening and rotation issues) requiring reimplantation and careful functional testing.
• Successful valve function was confirmed before final suture tying in all cases.

Conclusions:

• Anterolateral right thoracotomy provides excellent mitral valve exposure with minimal dissection in select cases.
• Traction on the anterior mitral leaflet facilitates anterior annular suture placement.
• Verification of prosthetic valve cusp motion is critical before securing sutures to prevent complications.