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Hinkov H, Greve D, Lee CB, Klein C, Dreysse S, Kukucka M, Akansel S, Falk V, Kofler M, Kempfert J. Combined Surgical and Percutaneous Management of Circumflex Artery Occlusion After Minimally Invasive Mitral Valve Repair. J Am Coll Cardiol 2024; 84:766-770. [PMID: 39142732 DOI: 10.1016/j.jacc.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 08/16/2024]
Abstract
This report describes a hybrid intervention addressing left circumflex artery occlusion during minimally invasive mitral valve repair. By using a radiopaque Cor-Knot device (LSI Solutions), targeted removal of occluding sutures was achieved, circumventing sternotomy and coronary artery bypass. Real-time coronary angiography provided assessment of procedural success during surgical revision in a hybrid operating room.
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Affiliation(s)
- Hristian Hinkov
- Department of Cardiothoracic and Vascular Surgery, Charité German Heart Center, Berlin, Germany; Charité-Berlin University Medicine, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany; German Center for Cardiovascular Research, partner site Berlin, Berlin, Germany.
| | - Dustin Greve
- Department of Cardiothoracic and Vascular Surgery, Charité German Heart Center, Berlin, Germany; Charité-Berlin University Medicine, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Chong Bin Lee
- Charité-Berlin University Medicine, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany; Department of Internal Medicine and Cardiology, Charité German Heart Center, Berlin, Germany
| | - Christoph Klein
- Charité-Berlin University Medicine, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany; Department of Internal Medicine and Cardiology, Charité German Heart Center, Berlin, Germany
| | - Stephan Dreysse
- Charité-Berlin University Medicine, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany; Department of Internal Medicine and Cardiology, Charité German Heart Center, Berlin, Germany
| | - Marian Kukucka
- Charité-Berlin University Medicine, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany; Department of Cardiac Anaesthesiology and Intensive Care Medicine, Charité German Heart Center, Berlin, Germany
| | - Serdar Akansel
- Department of Cardiothoracic and Vascular Surgery, Charité German Heart Center, Berlin, Germany; Charité-Berlin University Medicine, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Charité German Heart Center, Berlin, Germany; Charité-Berlin University Medicine, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany; German Center for Cardiovascular Research, partner site Berlin, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, Charité German Heart Center, Berlin, Germany; Charité-Berlin University Medicine, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany; German Center for Cardiovascular Research, partner site Berlin, Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Charité German Heart Center, Berlin, Germany; Charité-Berlin University Medicine, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
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Vardas P, DeLay TK, Stephens R, Abraham P, Lewis C. Robotic Redo Mitral Valve Replacement and Atrioventricular Groove Pseudoaneurysm Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:577-580. [PMID: 36539932 DOI: 10.1177/15569845221141706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We report the use of robot-assisted right thoracotomy in the management of a patient who presented with acute-on-chronic congestive heart failure, associated with a contained atrioventricular dissection and 2 prior mitral valve replacements. Our patient had evidence of a contained rupture, as represented by preoperative cross-sectional imaging. The anatomic sequela from this was a ventricular pseudoaneurysm, which was likely survivable due to adhesions from prior operations buttressing the margins of the defect. Expansion of the pseudoaneurysm likely contributed to the dehiscence of the prosthesis. Our case illustrates an unprecedented resolution of a serious complication, managed effectively and efficiently by a robot-assisted procedure. With a successful outcome of totally endoscopic and robot-assisted repair, we demonstrate the versatility of minimally invasive techniques in addressing complicated anatomy as well as a surgical field scarred by multiple prior surgeries.
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Affiliation(s)
- Panayotis Vardas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Thomas Kurt DeLay
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Richard Stephens
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Peter Abraham
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Clifton Lewis
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, AL, USA
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Intraprocedural cardiac complications of transcatheter aortic and mitral valve interventions: "The eyes do not see what the mind does not know". CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:144-152. [PMID: 34053872 DOI: 10.1016/j.carrev.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 11/20/2022]
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Dello SA, Leus SJ, Tan MES, Otterspoor LC, Botman CJ. Percutaneous coronary intervention of an iatrogenic occlusion of the circumflex coronary artery after mitral valve replacement. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 9:NP1-NP2. [PMID: 26684791 DOI: 10.1177/2048872615623066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Occlusion of the circumflex coronary artery by compromising sutures is a serious complication in patients undergoing mitral valve replacement. The majority of such patients have to undergo bypass surgery or redo mitral valve replacement. We report a case of an iatrogenic occlusion of the circumflex coronary artery after mitral valve replacement that was treated by percutaneous coronary intervention.
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Affiliation(s)
- Simon Awg Dello
- Department of Cardiology, Catharina Hospital Eindhoven, The Netherlands
| | - Stefan Jl Leus
- Department of Cardiology, Catharina Hospital Eindhoven, The Netherlands
| | - M Erwin Sh Tan
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, The Netherlands
| | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital Eindhoven, The Netherlands
| | - Cees-Joost Botman
- Department of Cardiology, Catharina Hospital Eindhoven, The Netherlands
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Salna M, Witer L, Argenziano M, Takeda K. Novel adjunctive use of venoarterial extracorporeal membrane oxygenation in atrioventricular groove disruption following mitral valve surgery. JTCVS Tech 2020; 3:213-215. [PMID: 34317876 PMCID: PMC8302935 DOI: 10.1016/j.xjtc.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Michael Salna
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Lucas Witer
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael Argenziano
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
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Nagamine H, Date Y, Takagi T, Kawase Y. To repair or not to repair: a case report of atrioventricular groove hematoma during mitral valve surgery. J Cardiothorac Surg 2019; 14:8. [PMID: 30626444 PMCID: PMC6327444 DOI: 10.1186/s13019-018-0828-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atrioventricular groove hematomas during mitral valve surgery range from simple hematomas to complex atrioventricular disruptions that cause frank rupture with massive bleeding and subsequent mortality. A small or moderate-sized hematoma is reported to be present in the left atrioventricular groove in 10 to 30% of all patients immediately after mitral valve replacement. Despite the fact that atrioventricular groove hematomas are inherently unstable and unpredictable, conservative strategies are recommended due to the high mortality associated with additional surgical repair. Such conservative strategies, however, would not resolve the potential risk of rupture, and there also appears to be a certain degree of uncertainty to be overcome using the current advances in cardiac surgery. CASE PRESENTATION We present a case of atrioventricular hematoma during double valve replacement which was treated with conservative management. A left ventricular pseudoaneurysm developed after surgery, but spontaneously resolved completely within six months. After reflecting on our case, we developed a check sheet, including the anesthesiologist's transesophageal echocardiography findings, for reasonable intraoperative decision-making regarding conservative management vs. additional surgical repair. Our check sheet helps organize the pathophysiological understanding of the injury and integrates partial findings from complementary viewpoints, and can be used to accurately assess intense situations and develop a common understanding among surgical team members. CONCLUSIONS Our case involved an atrioventricular groove hematoma that occurred during mitral valve surgery and caused a left ventricular pseudoaneurysm. Conservative strategies yielded positive results. We hope our experience and original check sheet will be of value to surgical teams facing similar situations.
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Affiliation(s)
- Hiroshi Nagamine
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Kanagawa 247-8581 Japan
| | - Yusuke Date
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Kanagawa 247-8581 Japan
| | - Takeshi Takagi
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Kanagawa 247-8581 Japan
| | - Yushi Kawase
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Kanagawa 247-8581 Japan
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Abel SA, Stark TA, Rehfeldt KH, Rihal CS, Said SM. Modified Cabrol Shunt for Atrioventricular Groove Rupture After Mitral Valve Replacement. Ann Thorac Surg 2017; 105:e11-e13. [PMID: 29233353 DOI: 10.1016/j.athoracsur.2017.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/01/2017] [Accepted: 07/07/2017] [Indexed: 11/28/2022]
Abstract
Rupture of the atrioventricular (AV) groove is the Achilles' heel of mitral valve replacement, and it has been associated with high rates of mortality. Here, we report successful management of a type 1 AV groove disruption using a modified Cabrol shunt to the right atrium in a patient with a severely calcified mitral annulus.
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Affiliation(s)
- Stuart A Abel
- Department of Cardiovascular Surgery and Division of Cardiothoracic Anesthesia, Mayo Clinic, Rochester, Minnesota
| | - Thomas A Stark
- Department of Cardiovascular Surgery and Division of Cardiothoracic Anesthesia, Mayo Clinic, Rochester, Minnesota
| | - Kent H Rehfeldt
- Department of Cardiovascular Diseases and Division of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases and Division of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sameh M Said
- Department of Cardiovascular Surgery and Division of Cardiothoracic Anesthesia, Mayo Clinic, Rochester, Minnesota.
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Gualis J, Castaño M, Rodríguez MA, García C. Late Chronic Tamponade after Intraoperative Right Ventricular Rupture Repair with Mediastinal Fat. Thorac Cardiovasc Surg Rep 2015; 4:25-7. [PMID: 26693122 PMCID: PMC4670302 DOI: 10.1055/s-0035-1544218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/02/2014] [Indexed: 11/26/2022] Open
Abstract
Advanced age and female sex are known risk factors for ventricular wall rupture during open-heart procedures. We present the case of an 83-year-old female patient with an intraoperative traumatic right ventricular free wall rupture during an aortic valve replacement procedure. Pledgetted interrupted sutures reinforced with large pieces of mediastinal fat were used for rupture repair. After 6 months, the patient was readmitted with the diagnosis of a retrosternal mediastinal mass and clinical signs of cardiac tamponade that required reoperation.
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Affiliation(s)
- Javier Gualis
- Department of Cardiac Surgery, Complejo Asistencial Universitario de León, León, Spain
| | - Mario Castaño
- Department of Cardiac Surgery, Complejo Asistencial Universitario de León, León, Spain
| | | | - Cristina García
- Department of Cardiac Surgery, Complejo Asistencial Universitario de León, León, Spain
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Gualis J, Castaño M, Rodríguez M, García C. Taponamiento cardiaco atípico en una paciente octogenaria. Rev Clin Esp 2015; 215:292-3. [DOI: 10.1016/j.rce.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/16/2014] [Indexed: 11/29/2022]
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