Redo Mitral Valve Surgery With Previous Aortic Valve Replacement

This video demonstrates the case of an 84-year-old woman who had previously undergone aortic valve replacement and CABG x 3, and who then developed severe mitral valve regurgitation. All the grafts were left sided, and the right ventricle was stuck to the back of the sternum on the CT scan. 

The femoral artery and vein were prepared in case of complications, though they were not needed in the end; however, the femoral vein was used for venous return.  

The right atrium was opened, and then the fossa ovalis was opened. Accessing the mitral valve was challenging due to the previously placed aortic valve. Dr. Gaudiani  recommended taking a suture to the anterior leaflet to pull it down, allowing for better access to place the sutures for the valve. The steps for placing the annulus sutures are shown in the video. 

Once the sutures were placed, the Mitris Resilia mitral valve, which has shorter struts than other valves, was inserted making it ideal for this patient. The total cross-clamp time was 62 minutes.  

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