Rupture of atrioventricular groove after mitral valve replacement. Can we do better ?
Orestis Argiriou, Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece
21 April 2015
Authors: Argiriou O.1, Patris V.1
1: Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece
We read with interest the excellent case report by Jin-Tae Kwon et al, regarding the succesful repair of an atrioventricular groove rupture, during mitral valve replacement (MVR) on an elderly patient.1 Although the rupture was successfully repaired, this complication proves to be quite frequent in elderly patients, and even fatal in many cases, as it is mentioned by the article’s authors and others.1,2. Specifically, the intra-operative mortality is even higher than 50%, despite the efforts of surgical closure of the rupture. What also proves to be a significant factor of negative prognosis, is the prolonged operative time (on-pump time: 441 minutes, aortic cross-clamp time: 190 minutes). Recently, efforts have been focused towards an off-pump repair, with external approach.3 Comparing the two methods as far as mortality is concerned (in a small series of patients, though), the off-pump technique seems to be superior to the surgical endocardial repair, as the one-year-survival rate of the off-pump technique is 100%. A simple but useful technique has been described by our team, where off-pump “tissue sealing” was performed with the assistance of the intra-aortic balloon pump.4
References
Kwon J, Jung T, Lee D. The rupture of atrioventricular groove after mitral valve replacement in an elderly patient Journal of Cardiothoracic Surgery 2014, 9 :28 (8 February 2014)
Hosono M, Shibata T, Sasaki Y, Hirai H, Bito Y, Takahashi Y, Suehiro S. Left ventricular rupture after mitral valve replacement: risk factor analysis and outcome of resuscitation. J Heart Valve Dis. 2008 Jan;17(1):42-7.
Schuetz A, Schulze C, Wildhirt SM: Off- pump epicardial tissue sealing – a novel method for atrioventricular disruption complicating mitral valve procedures. Ann Thorac Surg 2004, 78:569–573.
Argiriou M, Patris V, Lama N, Argiriou O, Charitos C. Off pump repair of left ventricular rupture following mitral valve replacement: The crucial assistance of the IntraAortic Balloon Pump. Int J Surg Case Rep. 2013;4(1):5-6.
Rupture of atrioventricular groove after mitral valve replacement. Can we do better ?
21 April 2015
Authors: Argiriou O.1, Patris V.1
1: Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece
We read with interest the excellent case report by Jin-Tae Kwon et al, regarding the succesful repair of an atrioventricular groove rupture, during mitral valve replacement (MVR) on an elderly patient.1 Although the rupture was successfully repaired, this complication proves to be quite frequent in elderly patients, and even fatal in many cases, as it is mentioned by the article’s authors and others.1,2. Specifically, the intra-operative mortality is even higher than 50%, despite the efforts of surgical closure of the rupture. What also proves to be a significant factor of negative prognosis, is the prolonged operative time (on-pump time: 441 minutes, aortic cross-clamp time: 190 minutes). Recently, efforts have been focused towards an off-pump repair, with external approach.3 Comparing the two methods as far as mortality is concerned (in a small series of patients, though), the off-pump technique seems to be superior to the surgical endocardial repair, as the one-year-survival rate of the off-pump technique is 100%. A simple but useful technique has been described by our team, where off-pump “tissue sealing” was performed with the assistance of the intra-aortic balloon pump.4
References
Competing interests
No conflict of interest