Key result
Right thoracotomy MVR under VF succeeds as bail-out for MitraClip failure with unclampable aorta.
Why the study?
Surgical treatment of valvular disease carries high risk in patients with prior cardiovascular surgery or severe aortic calcification, presenting a need to report alternative strategies when MitraClip complications occur.
Case Report (n=1)
No
Right thoracotomy mitral valve replacement under ventricular fibrillation without aortic cross-clamping is a viable surgical strategy for patients with a porcelain aorta and prior CABG who experience complications from MitraClip.
May support this bail-out in select high-risk cases; leaves open need for prospective validation before wider adoption.
心臓血管手術歴や大動脈高度石灰化のある患者の弁膜症治療は外科的治療のリスクが高い．今回，経皮的僧帽弁接合不全修復術の合併症をきたした症例に対して準緊急で大動脈遮断を行わずに僧帽弁置換術を施行した．症例は31年前に冠動脈バイパス術の既往がある83歳男性．重症僧帽弁閉鎖不全症による心不全を生じた．経皮的僧帽弁接合不全修復術を施行したが弁尖に交絡し僧帽弁狭窄症のため循環動態不安定となった．陶器様大動脈と冠動脈バイパスグラフト存在のため大動脈遮断困難と判断し，心室細動下右側開胸鏡視下僧帽弁置換術を施行し，良好な経過を得た．心室細動下側開胸手術は大動脈遮断困難である症例の手術戦略として有用と考えられた．
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Tamai et al. (2025) conducted a case report in Mitral stenosis after MitraClip failure (n=1). Mitral valve replacement under ventricular fibrillation via right thoracotomy was evaluated on Surgical success and postoperative recovery. Mitral valve replacement via right thoracotomy under ventricular fibrillation was safely and successfully performed as a bail-out strategy for a patient with MitraClip failure and an unclampable aorta.
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