What does this research mean for the field?

Tailored anaesthetic management and femorofemoral bypass enable stable hemodynamics and successful recovery in high-risk patients undergoing a third open-heart surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To explore anaesthetic management challenges and strategies in high-risk patients undergoing reoperative cardiac surgery.

March 5, 2026Bangabandhu Sheikh Mujib Medical University Journal0 citationsOpen Access

Successful anaesthetic management in a patient scheduled for open-heart surgery for the third time: A case report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: 48-year-old man with severe mitral valve dysfunction and multiple comorbidities undergoing third open-heart surgery for mitral valve replacement (n=1). Intervention: Redo mitral valve replacement with 25 mm On-X mechanical mitral valve under general anaesthesia, invasive hemodynamic monitoring, and femorofemoral cannulation cardiopulmonary bypass. Primary outcome: Successful open-heart surgery with stable postoperative recovery and discharge.

MNMostafa NuruzzamanDhaka Medical College and Hospital SSSanjoy Kumar SahaShaheed Suhrawardy Medical College MRMohammad Meshbahur Rahman

Key Result

Redo mitral valve replacement with tailored anaesthetic management and femorofemoral bypass enabled stable hemodynamics and successful discharge in a 48-year-old man undergoing third open-heart surgery.

Key Points

To explore anaesthetic management challenges and strategies in high-risk patients undergoing reoperative cardiac surgery.
Detailed case report of a patient undergoing third open-heart surgery.
Individualised anaesthetic management plan created for a patient with multiple comorbidities.
Utilisation of invasive haemodynamic monitoring and femorofemoral cannulation for stability during surgery.
Patient experienced transient desaturation, managed with targeted therapy.
Successfully extubated on postoperative day three.
Patient discharged in stable condition, indicating a favourable outcome.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 48-year-old man (n=1) with severe bioprosthetic mitral valve dysfunction (stenosis and regurgitation), NYHA class III, LVEF 40%, and a history of two prior open-heart surgeries (atrial septal defect closures and mitral valve replacement).

Intervention

Third open-heart surgery for redo mitral valve replacement using a 25 mm On-X mechanical valve, with cardiopulmonary bypass established via femorofemoral cannulation and tailored anaesthetic management (midazolam, fentanyl, thiopental, vecuronium, and inotropic support).

Outcome

Successful surgical outcome and discharge

Multidisciplinary planning and individualized anaesthetic strategies, including femorofemoral cannulation and invasive monitoring, enable successful outcomes in high-risk third-time open-heart surgeries.

Limitations

Single patient case report limits generalizability
No control group or comparative data
Results may not be applicable to other settings or patient populations

Abstract

Background: Anaesthetic management of patients undergoing third open-heart surgery presents significant challenges due to anatomical distortions, adhesions, and altered haemodynamics. Patients with complex comorbidities require meticulous planning to mitigate perioperative risks. Case description and management: This report presents the case of a 48-year-old man with severe mitral valve dysfunction and multiple comorbidities who underwent redo mitral valve replacement. A comprehensive anaesthetic management plan was tailored to the patient, incorporating invasive haemodynamic monitoring with a coordinated multidisciplinary strategy. Cardiopulmonary bypass was established using femorofemoral cannulation, ensuring haemodynamic stability during the procedure. Postoperative care involved vigilant monitoring of haemodynamic and respiratory complications. The patient experienced transient desaturation, which was effectively managed with targeted therapy. The patient was extubated on postoperative day three and discharged in stable condition. Conclusion: This case highlights the critical importance of multidisciplinary planning, individualised anaesthetic strategies, and proactive postoperative management in high-risk reoperative cardiac surgery to achieve favourable outcome.

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Cite This Study

Nuruzzaman et al. (Mon,) conducted a case report in 48-year-old man with severe mitral valve dysfunction and multiple comorbidities undergoing third open-heart surgery for mitral valve replacement (n=1). Redo mitral valve replacement with 25 mm On-X mechanical mitral valve under general anaesthesia, invasive hemodynamic monitoring, and femorofemoral cannulation cardiopulmonary bypass was evaluated on Successful open-heart surgery with stable postoperative recovery and discharge. Redo mitral valve replacement with tailored anaesthetic management and femorofemoral bypass enabled stable hemodynamics and successful discharge in a 48-year-old man undergoing third open-heart surgery.

synapsesocial.com/papers/69a91cf1d6127c7a504bfdd7 https://doi.org/https://doi.org/10.3329/bsmmuj.v19i1.82283

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