Transaortic repair of concomitant mitral insufficiency in patients with critical aortic stenosis undergoing aortic valvular replacement

Abstract

Background: In this study, we present operation technique and outcomes of transaortic mitral valve repair in high-risk patients undergoing aortic valve replacement due to severe aortic stenosis. Methods: Between January 2005 and March 2016, a total of 11 patients (7 females, 4 males; mean age 71.2 +/- 4.1 years; range, 65 to 77 years) with severe aortic valve stenosis (aortic valve area <1 cm(2) or aortic valve area index <0.6 cm(2)/m(2)) and concomitant moderate or severe mitral regurgitation (non-ischemic, regurgitant jet origin between A2-P2 portions) secondary to left ventricular dysfunction (EuroSCORE logistic score >5%, left ventricular ejection fraction <30%) who were operated were retrospectively analyzed. Aortic valve replacement and transaortic mitral edge-to-edge repair was applied to all patients. Operations were performed through sternotomy, cardiopulmonary bypass, and bicaval venous return. Transesophageal echocardiography was used to evaluate mitral valve before surgery and valve functions after surgery. Postoperative course of all patients was monitored, and postoperative complications were recorded. Results: The mean preoperative ejection fraction was 24.5 +/- 4.1% and the mean transaortic pressure gradient was 35.8 +/- 4.8 mmHg. The mean aortic cross-clamp time was 62.09 +/- 10.1 (range, 43 to 76) min and the median cardiopulmonary bypass time was 90.1 +/- 11.9 (range, 66 to 114) min. No hospital mortality was observed. In the postoperative period, two patients experienced renal insufficiency. Hemofiltration was initiated in these patients and no dialysis was required at two weeks. One patient had postoperative atrial fibrillation and one patient had pericardial effusion leading to cardiac tamponade and this patient underwent reoperation. The patients were followed up for a mean of four years and control echocardiography didn't detect increase in mitral regurgitation degree. Conclusion: Transaortic edge-to-edge mitral valve repair can be used in high-risk patients undergoing aortic valve replacement. This technique is feasible with shorter cross-clamp time and can reduce mortality and morbidity in selected high-risk patients.