Safe Cerebral Protection: Double Patch Technique for Aortic and Mitral Valve Replacement

This patient required a double valve replacement, but she had grade V atheroma in the ascending aorta. This meant that the patient was at very high risk of stroke if routine techniques were used. 

Because of the patient’s high risk of stroke, the left carotid artery was cannulated and proximally clamped. The brain was perfused at one liter per minute through this cannula, which meant that no atheroma could pass up into the head vessels as blood passed back in a retrograde fashion down the opposite carotid artery. 

The aorta was then opened and the small aortic valve was visualized, showing that a root enlargement was clearly needed. The annulus was opened through the middle of the anterior leaflet of the mitral valve and opened into the left atrium. Next, the anterior and then posterior leaflets of the mitral valve were removed from the aorta. Mitral annular calcification was also discussed. 

The mitral sutures were then placed in a horizontal mattress technique and a mitral annulus enlargement patch was placed, which increased the size of both the mitral and aortic annuluses. A Dacron patch was then placed and, after the mitral valve, the aortic valve was sutured into place with the annular and aortic enlargement patch.

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