Key result
Mitral valve re-repair via repeated right anterior minithoracotomy successfully resolves early failure at 9 months.
Why the study?
The authors aimed to demonstrate the surgical technique of mitral valve re-repair via repeated right anterior minithoracotomy for early repair failure caused by left ventricular positive remodeling and chordal pseudo-elongation.
Case Report (n=1)
No
Redo minimally invasive cardiac surgery via repeated right anterior minithoracotomy is a viable and effective option for mitral valve re-repair following early procedure-related failure.
May warrant consideration in experienced centers for early mitral repair failure; leaves open durability and generalizability beyond this case.
OBJECTIVE: We aim to show the step-by-step surgical technique of mitral valve re-repair by means of a repeated right anterior minithoracotomy in a case of a procedure-related early mitral valve repair failure due to left ventricular positive remodeling and chordal pseudo-elongation. METHODS: The patient was readdressed to our institution for an early severe mitral valve regurgitation, less than a year after performing a right minithoracotomy mitral valve repair (42-mm annular ring implantation, P2 triangular resection, and P2 neochord positioning). The mechanism was attributed to a positive left ventricle remodeling and neochordal pseudo-elongation. Therefore, we decided to perform a mitral valve re-repair in a redo minimally invasive cardiac surgery. We describe in a video-guided step-by-step fashion the surgical procedure, from the reopening of the right anterior minithoracotomy to the surgical strategy chosen to address the re-repair, guided by the mechanism of the previous repair failure. RESULTS: We replaced the previously implanted ring with a smaller one and positioned a new polytetrafluoroethylene 4-0 neochord at the P2 level. The patient was discharged home on the fifth postoperative day after an uneventful hospital stay. Predischarge echocardiogram demonstrated undetectable residual mitral valve regurgitation. At 3-month follow-up, echocardiographic and clinical data were encouraging. At 9-month follow-up, the patient endorsed no recurrence of cardiologic symptoms. CONCLUSIONS: Redo minimally invasive cardiac surgery is a viable option even in case of a mitral valve re-repair due to previous repair failure, especially when procedure related in degenerative mitral disease. Combining the benefits of mitral valve re-repair with those of a minimally invasive surgery may optimize short-term and long-term outcomes.
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Çelmeta et al. (2022) conducted a case report in Early severe mitral valve regurgitation due to repair failure (n=1). Mitral valve re-repair via repeated right anterior minithoracotomy was evaluated on Surgical success and clinical outcomes (residual mitral regurgitation and symptoms). Mitral valve re-repair via repeated right anterior minithoracotomy successfully treated early repair failure, resulting in undetectable residual regurgitation and no symptom recurrence at 9 months.
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