Original Experience of Transaortic Approach in Bivalve Replacement

Background. Combined valve lesions affect more than one valve, which may hamper a correct estimation of the individual valve severity. The study aimed to assess the outcome of transaortic mitral valve replacement (TAMVR) in a bivalve replacement procedure.

Materials and methods. A retrospective study was conducted with 19 patients having TAMVR during bivalve replacement. The mean patient age was 58 ± 8.6 years, including 10 male patients. Diabetes mellitus was diagnosed in 3 patients, atrial fibrillation — in 14, coronary heart disease — in 2, chronic obstructive pulmonary disease — in 2, stroke in history — in 1, chronic heart failure stage 3–4 (NYHA) — in 19 patients.  Infectious endocarditis as the disease aetiology was found in 4 patients. Two patients had previous heart surgery. Echocardiography: mean left ventricular ejection fraction 55 ± 7.3 %, mean pulmonary artery pressure 47 ± 13.7 mm Hg, median aortic valve fibrous ring diameter 23 (21–25) mm.

Results and discussion. Mechanical replacement was performed in 12 cases. Median surgery time was 160 (150–185) min, median myocardial ischaemia (MI) time — 67 ± 9.7 min and artificial circulation (AC) time — 87 ± 12.5 min. Resternotomy for bleeding was performed in 2 patients, with median postoperative blood loss  300 (212–587) mL. Early postoperative delirium developed in 4 patients, acute renal failure requiring  haemodialysis — in 1 patient. Stroke, perioperative myocardial damage and conduction disorder requiring pacemaker implantation not observed in postoperative period. Median artificial lung ventilation time (ALV) was 9.5 (6–15) h, ≥24 h — in two cases. One lethal early postoperative case was registered.

Conclusion. TAMVR in a bivalve replacement setting is a safe technique with short AC, MI and surgery times and can be recommended in patients with a wide aortic valve fibrous ring.

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