[Knack and pitfall in valve replacement]

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair and Replacement
• Surgical Echocardiography

Context:

• Adherence to American Heart Association/American College of Cardiology guidelines is crucial for selecting prosthetic or bioprosthetic valves.
• Preserving the native valve annulus during aortic valve replacement requires meticulous removal of calcification, avoiding over-resection.
• Mitral valve replacement in cases of a large mitral annulus involves preserving the posterior leaflet and basal chordae.

Purpose:

• To detail critical surgical considerations and techniques in heart valve replacement procedures.
• To underscore the importance of intraoperative transesophageal echocardiography in identifying potential complications.
• To report the outcomes and complication rates of a series of heart valve replacement surgeries.

Summary:

• Specific surgical techniques, including annulus preservation and leaflet management, are described for aortic and mitral valve replacements.
• Suturing techniques are detailed to ensure secure prosthetic valve implantation and annulus attachment.
• Intraoperative transesophageal echocardiography is utilized for real-time detection of stack valves, perivalvular leakage, and air embolism.

Impact:

• The study reports a low mortality rate of 1.9% and a re-operation rate of 3.8% for infective endocarditis in 53 valve replacement cases.
• Findings suggest that careful surgical technique and intraoperative monitoring contribute to favorable outcomes in heart valve replacement.
• This work provides valuable insights for cardiac surgeons performing valve replacement procedures, aiming to minimize complications and improve patient results.