Department of Cardiovascular Surgery, Health Sciences University, Ahi Evren Thoracic and Cardiovascular Surgery Training Research Hospital, Trabzon, Turkey.
Deparment of Cardiopulmonary Rehabilitation, Health Sciences University, Ahi Evren Thoracic and Cardiovascular Surgery Training Research Hospital, Trabzon, Turkey.
Tex Heart Inst J. 2023 Jan 1;50(1). doi: 10.14503/THIJ-21-7563.
Surgical approaches for mitral valve exploration vary, with the preferred approach being via the interatrial groove. Data on whether the interatrial groove approach can be used for mitral valve surgery in patients with a previously implanted Amplatzer septal occluder (ASO) (St Jude Medical, an Abbott company) are extremely limited. The authors performed mitral valve surgery using the transatrial septal approach on 2 patients following explantation of an ASO, which significantly impedes the interatrial groove approach. Concomitant surgical procedures with mitral valve replacement, removal of the ASO, and closure of an atrial septal defect with a patch significantly prolonged the cross-clamp and cardiopulmonary bypass durations, which is the reason for intraoperative low cardiac output syndrome. An intra-aortic balloon pump and venoarterial extra-corporeal membrane oxygenation were used in these 2 patients because of low cardiac output syndrome. When planning mitral valve surgery in patients with a previously implanted ASO, the device precludes the interatrial groove approach and can produce an unpredictable clinical scenario.
二尖瓣探查的手术入路各异，首选的入路是通过房间隔沟。关于在先前植入 Amplatzer 房间隔封堵器（ASO）（圣犹达医疗公司， Abbott 旗下公司）的患者中是否可以使用房间隔沟入路进行二尖瓣手术的数据极其有限。作者对 2 例在取出 ASO 后使用经房间隔入路进行二尖瓣手术的患者进行了研究，ASO 显著阻碍了房间隔沟入路。二尖瓣置换术、ASO 取出术和补片封闭房间隔缺损的同时进行显著延长了体外循环和主动脉阻断时间，这是术中低心输出综合征的原因。这 2 例患者均因低心输出综合征而使用了主动脉内球囊泵和静脉动脉体外膜肺氧合。当计划对先前植入 ASO 的患者进行二尖瓣手术时，该装置会妨碍房间隔沟入路，并可能产生不可预测的临床情况。
