This is a unique case of a 64-year-old man who had a history of Hodgkins disease with mantle radiation to his chest. I had performed a surgical aortic valve replacement 10 years prior with a biological valve that is still working well.
The patient now presented with critical mitral stenosis due to progressive development of heavy calcification on the mitral valve. A complicating factor is that he had also developed progressive calcification of his aortic root and ascending aorta, yet remarkably, as mentioned, his biologic prosthetic aortic valve was still functioning normally.
To preserve the well-functioning prosthetic aortic valve, we now performed a left thoracotomy approach, using femoral cannulation to establish cardiopulmonary bypass, beating heart and ventricular fibrillation, without cardiolegic arrest.
The patient is now six days after surgery and states that he has no pain. He is looking forward to going home tomorrow.
A left thoracotomy approach is an excellent choice for complex redo-mitral valve surgery, particularly in the presence of a previously placed, well-functioning prosthetic aortic valve. It allows for excellent visualization of the mitral valve, without interference from the nearby prosthetic aortic valve, and without the need for cardioplegic arrest.
Special thanks to my colleague, mentor, and friend, Dr. Scott Goldman, at Main Line Health, who provided insights into his experiences with this novel approach.
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