Emergency Mitral Valve Replacement Due To Ruptured Artificial Chordae Of The Neochord Device Seven Months After Implantation
Marieluise Harrer, Reinhard Moidl, Stefanie Wallner.
Hospital Floridsdorf, Vienna, Austria.
Patient: The patient was a 78-year-old man with NYHA class IV with severe mitral regurgitation due to a flail of the posterior leaflet. Seven months ago 3 neo-chordae were implanted (NeoChord DS 1000 device) through a trans-apical access in beating heart off-pump technique. A rupture of 2 or 3 neo-chordae was suspected in the transthoracic echocardiography and confirmed in intraoperative transesophageal echocardiography. In addition, relevant echocardiographic findings were the poor right ventricular function, a slightly reduced left ventricular function and an elevated sPAP of 79 mmHg. Procedure: The patient came direct from the emergency department to the operating theatre. He was haemodynamically unstable leading to pharmacologically reanimation under anaesthetization. A full sternotomy was done and cardiopulmonary bypass (CPB) was initiated rapidly. There were only few adhesions in the area of the apex. The intraoperative evaluation of the mitral valve showed a rupture in the middle part of all 3 implanted neo-chordae. Afterwards a valve replacement using a 29 mm biological prosthesis was performed. The aortic cross clamp time was 64 minutes and CPB time was 130 minutes. Due to poor RVF the chest remains open. At the second postoperative day, the chest could be closed under stable hemodynamic, as well as respiratory conditions. Postoperative Course: After prolonged intensive care unit stay the patient could be transferred to intermediate care and standard care. At the 57 postoperative day, he could be discharge to home care. Before discharge, the performed transthoracic echocardiography showed a slightly reduced RVF and a sPAP of 24 mmHg with a good function of the mitral valve prosthesis. Conclusion: In an experience heart center, open heart surgery could be done successfully in a high risk patient after minimalinvasive trans-apical mitral valve repair.
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