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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Atrioventricular groove disruption following mitral valve replacement: A "life or death" surgical challenge
Session:
Posters 5 - Écran 8 - Doença Valvular
Speaker:
Manuela Silva
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Manuela Gouveia Silva; Carolina Rodrigues; Rui Pedro Cerejo; Nuno Banazol; Pedro Coelho; José Fragata
Abstract
<p><strong>Background and Objectives</strong></p> <p>Atrioventricular groove disruption (AVGD) or type I posterior ventricular rupture following mitral valve replacement (MVR) is a rare but catastrophic complication with a mortality rate as high as 75%. Incidence ranges from 0,5% to 2%, with few series reported in the literature. Multiple factors such as heavy mitral annular calcification, posterior leaflet resection, increased tissue friablity, reoperations and global fraility in the eldery population, have been associated with AVGD. We report our surgical experience in AVGD correction.</p> <p><strong>Methods</strong></p> <p>A single-center retrospective review of all consecutive patients with AVGD following MVR in the past decade was performed. Two surgical strategies have been applied, namely, the internal reapir with explantation of the prothesis, reconstruction of the AVG using a felt patch and prothesis reimplantation, and the the external approach using autologous or heterologous pericardial patch, felt-reinforced suturing and biological glue application. Both techniques implied reinstitution of cardiopulmonary bypass, cardioplegic arrest and complete decompression of the heart.</p> <p><strong>Results</strong></p> <p>Between January of 2007 and October of 2018, 395 patients underwent isolated MVR in our hospital and AVGD occured in 5 patients (1,3%). Average age in this subgroup of patients was 72,8 years (range, 66-80 years), and all female gender. Sixty percent (3 of 5) of the AVGD were early ruptures, detected intraoperatively and 2 patients (40%) had a delayed rupture diagnosed in the first postoperative day. Internal repair was performed in 3 patients: one delayed rupture and 2 early ruptures, one of the later combined with the external technique and an adicional safenous vein bypass grafting to the first obtuse marginal due to the injury of the circunflex artery. The external strategy was applied in the remainer 2 patients. An intraaortic ballon pump was used in 3 patients. Two patients died intraoperatively, both who underwent isolated internal repair, and survival rate at discharge was 60% (3 of 5). Currently, all three patients remain alive.</p> <p><strong>Conclusion</strong></p> <p>AVGD is a dreadful, highly lethal and, probably, an underestimated complication of MVR. The ideal repair technique remains a matter of debate. Patient individual evaluation and risk assessment are crucial in decision making. Despite our small serie of patients, we consider the external approach an effective repair strategy for rescue of AVGD.</p>
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