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Left circumflex artery injury postmitral valve surgery, single center experience

Aysha Husain1, Aly Alsanei1, Mohammed Tahir1

  • 1Heart Center, King Faisal Hospital and Research Center, Riyadh Saudi Arabia.

Journal of the Saudi Heart Association
|February 16, 2019
PubMed

Insights

Left circumflex artery injury during mitral valve surgery is a rare but serious complication, primarily occurring after valve replacement. Early diagnosis and intervention, potentially via percutaneous coronary intervention, are crucial for patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Cardiac Anatomy

Background:

  • The left circumflex (LCX) artery's proximity to the mitral valve (MV) poses a risk of injury during MV surgery.
  • Mitral valve surgery, particularly replacement, has been associated with LCX artery injury.

Purpose of the Study:

  • To report the experience in diagnosing and managing left circumflex artery injury following mitral valve surgery.
  • To evaluate the incidence, clinical presentation, and treatment outcomes of this complication.

Main Methods:

  • Retrospective review of surgical and coronary angiography databases.
  • Analysis of patient data from January 2000 to December 2016 for documented LCX artery injury during MV surgery.

Main Results:

  • The complication occurred in 0.7% of MV replacement cases (9/1313) but not in MV repair (0/393).
  • Most affected patients were female (88.9%) with a mean age of 40.4 years, presenting with ECG ischemic changes and ventricular arrhythmias.
  • Treatment included percutaneous coronary intervention (33.3%) or redo surgery (66.7%), with a high 30-day mortality (33.3%).

Conclusions:

  • A high index of suspicion is necessary for diagnosing LCX artery injury post-MV surgery.
  • Optimal treatment strategy remains debated; percutaneous intervention is proposed as a primary option to avoid repeat open-heart surgery.
Keywords:
coronary artery diseasecoronary bypass graftsmitral valve diseasepercutaneous coronary interventionvalvular surgery

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