Repair of type A dissection with mitral regurgitation using total arch replacement with mitral valve surgery

Mitral regurgitation (MR) is very rare in patients with type A dissection. We retrospectively reviewed our experience of total arch replacement (TAR) with mitral valve surgery for type A dissection with MR.

From November 2009 to October 2012, 14 patients with type A dissection (chronic = 11; acute = 3) with MR underwent TAR combined with mitral valve surgery under hypothermic cardiopulmonary bypass with selective cerebral perfusion. The Bentall procedure was performed in 11 patients, aortic valve replacement (AVR) in one patient, coronary artery bypass grafting (CABG) in three patients, and tricuspid valvuloplasty (TVP) in one patient.

Thirty-day mortality was 7.1% (1/14). One patient died after transfer to another hospital secondary to renal failure. Low cardiac output syndrome was observed in three patients (21.4%, 3/14), one of whom underwent left ventricular assist device implantation. Continuous renal replacement therapy was performed in four cases (28.6%, 4/14). Two patients underwent reoperation during follow-up period: One patient had mitral paravalvular leakage and the other dilatation of the thoracoabdominal aorta.

Repair of type A dissection with MR can be performed in a single operation. Combined TAR and mitral valve surgery is a much bigger and more complex operation associated with high morbidity.