Minimally Invasive Redo Mitral Valve Replacement: The Good, Bad and Ugly

Abstract

Objective: Redo minimally invasive heart valve surgery is always challenging. We gained an experience of Redo-MIS MVR in a 47yrs old lady, who had a previous history of mitral commissurotomy operation done 25yrs ago. Methods: This is a case report and experience sharing of a case done at Ibrahim Cardiac Hospital & Research Institute, Dhaka. Results: This otherwise healthy lady with NYHA class-III symptoms was evaluated and found to have a severe mitral re-stenosis. LVEF dropped down to 40%. Preoperative coronary angiogram was normal. Groin was explore and a Fem-Fem bypass established. A 5cm right antero-lateral thoracotomy was fashioned. Selective OLV and Co2 insufflation. Gradual dissection of plane except the apical area. Aortic ‘X’ clamp with modified Del-Nido cardioplegia. LAtomy approach to replace the grossly changed and deformed mitral valve. MVR done with 27mm ATS mechanical heart valve. ACX 72.23min, CPB 96.72 min, ICU stays 2 days with no reoperation and no in-hospital mortality. No paravalvular leak, AV block. Conclusions: The bad part of such surgery is the incremental difficulty for the surgeons; needs patience and cautions. The ugly part is not having a proper instrumentation, like external defibrillator. But the good part is the outcome. This patient received heart surgery twice in her life without a sternotomy.