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Total Arterial Complete Revascularization Using Bilateral IMA with Mitral Valve Replacement

Wednesday, April 29, 2015

A 62-year-old male was admitted in cardiogenic shock. He had previously received a dual chamber pacemaker for complete heart block. A coronary angiogram revealed triple vessel disease. A transthoracic echo showed that the patient had severe ischemic mitral regurgitation (coaptation depth of more than 10 mm), and severe left ventricle dysfunction (EF 25%). He was stabilized on IABP and was taken into surgery. He had varicose veins on both legs. He underwent total arterial complete revascularization with bilateral internal mammary artery and mitral valve replacement using a 27 mm mosaic valve. Both internal mammary arteries were dissected, and LIMA RIMA Y was made using 8-0 prolene sutures. A pump-assisted CABG was performed with LIMA to D1, LAD, and RIMA to OM1 and RCA.

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EF of 25% might be a reason for pump assisting CABG. It is just an attempt to decrease cardiac arrest time, and minimize detrimental effect of ischemia on LV with low EF. "Valve in Valve" procedure on mitral position is OK and I support that without reservation especially in cases like this. However, MVR is not an adequate terminology if such operative technique is used. Native mitral valve is totally preserved, thus MVR is just a confusing term.

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