Repair of left ventricular rupture following mitral valve replacement concomitant with left atrial reduction procedure--intracardiac patch and extracardiac buttress suture

Results and outcomes for patients with atrioventricular groove disruption after mitral valve surgery

BACKGROUND

Atrioventricular groove disruption (AVGD) is a rare and severe complication of mitral valve surgery (MVS). Current literature is limited to several case reports and series. Our aim was to analyze outcomes of patients with AVGD after MVS from our tertiary cardiac surgery center.

METHODS

Between June 2010 and January 2019, 18 patients suffering AVGD were identified in our institutional database and included in our retrospective observation. Preoperative, intraoperative and outcome data were analyzed using IBM SPSS Statistics. Late survival was estimated by using the Kaplan-Meier survival analysis.

RESULTS

The mean age of the study population was 76 ± 5 years. Most common indication for MVS was an isolated mitral valve insufficiency (67%). Severe annular calcification was present in four patients (22%). Majority of implanted valves were biological prosthesis (78%). Due to the location, 72% suffered type I rupture. External repair was performed in 94% of all patients. Second look operation in regard of excessive mediastinal hemorrhage was necessary in 67% of patients. Mean hospital stay of the presented collective was 13 ± 11 days with an intra-hospital mortality of 56%. Late follow-up was obtained in eight patients at an average of 3.1 (1.6-5.7) years postoperatively.

CONCLUSION

Mortality rates for AVGD after MVS are high. However, way of managing AVGD depends on the underlying type of rupture and should be evaluated in regard of the myocardial damage. Due to the rare occurrence, registry data might help to address more scientific value concerning therapeutic measures and outcomes of this severe complication.

Modified Cabrol Shunt for Atrioventricular Groove Rupture After Mitral Valve Replacement

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.

Left ventricular rupture post mitral valve replacement

Prevention is better than cure best applies here. As per many authors, posterior leaflet chordae preservation prevent Left ventricular rupture (LVR) and preserve LV geometry. We are presenting here 5 types of left ventricular rupture (LVR) post Mitral valve replacement (MVR) with different methods to repair with the advantages and disadvantages of each. The mortality rate is still very high despite the advances in cardiac surgery. Many therapeutic approaches have been adopted. Yet, none is ideal.

Spontaneous Atrioventricular Groove Disruption During Off-Pump Coronary Artery Bypass Grafting

Atrioventricular groove tear or disruption is a disastrous and technically challenging complication after mitral valve replacement surgery. This report details the untimely spontaneous occurrence of an atrioventricular tear during manipulation of the heart for off-pump coronary artery bypass grafting and its successful repair. Significant distortion of the mitral annulus and elevation of pulmonary artery pressures in the beating heart likely contributed to the spontaneous tear.