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Left Circumflex Artery Injury After Mitral Valve Surgery: An Algorithm Management Proposal.
Marta Bargagna1, Cinzia Trumello1, Alessandra Sala1
1Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
The Annals of Thoracic Surgery
|August 4, 2020
Summary
Left circumflex coronary (LCx) artery injury is a rare but serious complication of mitral valve surgery. Management depends on the type of injury, with coronary artery bypass grafting often preferred for total occlusion.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Complications
Background:
- Left circumflex coronary (LCx) artery injury is a life-threatening complication during mitral valve surgery.
- This study investigates LCx artery injury in a high-volume mitral surgery center.
Purpose of the Study:
- To describe the incidence, clinical presentation, and management of LCx artery injury following mitral valve surgery.
- To identify factors associated with LCx artery injury and evaluate treatment outcomes.
Main Methods:
- Retrospective review of 6501 mitral valve procedures performed between January 2004 and December 2017.
- Analysis of 10 patients who sustained an LCx artery injury, including coronary angiography findings and interventions performed.
- Data collected prospectively and reviewed retrospectively.
Main Results:
- An incidence of 0.15% (10 of 6501) for LCx artery injury was observed.
- LCx occlusion was more frequent in patients with left-dominant coronary circulation.
- Management strategies included coronary artery bypass grafting for total occlusion and percutaneous coronary intervention (PCI) for kinking, with varied outcomes.
Conclusions:
- LCx artery injury is uncommon but significant, particularly in patients with left-dominant coronary anatomy.
- Prompt diagnosis and tailored management are crucial for optimal outcomes.
- Coronary artery bypass grafting is recommended for total LCx occlusion, while PCI may be considered for kinking.
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