Aortic and Mitral Replacement With Double Patch Repair

This article is part of CTSNet’s series, Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani. CTSNet Senior Editor Dr. Vince Gaudiani presents nine surgical videos on the technical aspects of aortic valve replacement after TAVR. This series will conclude in three live learning roundtable events, scheduled at three different times to accommodate participants in multiple regions of the world. 

The patient was an 83-year-old woman who had a 20 mm transcatheter aortic valve replacement (TAVR) for aortic stenosis. She also had significant mitral disease that had not been treated due to high creatinine levels. Because she remained very short of breath, it was necessary to replace the mitral valve.  

Given that the patient had undergone a TAVR, the decision was made to open the aorta and remove the TAVR, which was functional. The TAVR was removed with the handlebar moustache technique. Once it was removed, the aortic annulus was opened with the intention of performing a double patch double valve technique, which Dr. Gaudiani has done more than 100 times previously. A Manougian style incision was made into the anterior mitral leaflet, but then the team decided to also remove the mitral leaflets.  

Next, the aortic valve sutures were placed, and the posterior mitral valve leaflet was removed through the aortic annulus. A patch was placed onto the posterior mitral annulus, and a tissue mitral valve was inserted through the aorta. A second patch was then placed as the mitral valve was sutured onto the atrium anteriorly. This patch was used both to close the atrium and to perform a Manougian aortic root enlargement. The aortic valve was successfully placed, and the aorta was closed with the patch, enlarging the aortic outflow tract. 

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.