Minimally Invasive Mitral Valve Replacement for Double Outlet Mitral Valve

Lowell C. Leow, Guohao Chang, Mohammad Z. Rahman, Theodoros Kofidis

Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore

Date, time and location: 2018.05.26 17:00, Exhibition area, 1st Floor. Zone – C

Abstract

Objective

We describe a case of minimally invasive mitral valve replacement for a 33 year old patient who presented with severe heart failure secondary to double outlet mitral valve regurgitation and refused median sternotomy.

Methods

A 33 year old Malay gentleman was admitted for acute onset heart failure secondary to severe mitral valve regurgitation complicated by fast atrial fibrillation. He was counseled for conventional mitral valve surgery but refused for fear of prolonged recovery following a median sternotomy. He was so afraid of surgery he absconded from the hospital, only to reattend a few days later with recurrent heart failure. The patient was offered suboptimal but less invasive Mitraclip therapy but during evaluation was found to have double outlet mitral valve which excluded him from the procedure. Minimally invasive mitral valve surgery was offered to the patient which he eventually agreed to. The patient successfully underwent a minimally invasive mitral valve replacement (St Jude’s #37), MAZE procedure and left atrial appendage ligation via a right anterior thoracotomy. The case was challenging due to a grossly dilated heart and aberrant anatomy.

Results

The operation went smoothly and the patient recovered well post operatively. He spent 1 day in ICU, 1 day in HD and another 6 days in the GW, mainly for bridging anticoagulation and warfarin titration. He had a few runs of non sustained ventricular tachycardia immediately post operatively which resolved by discharge and is currently in sinus rhythm. He was back to his baseline activity within 6 days from the operation and went back to work as a dispatch rider 2 weeks from discharge.

Conclusions

This is the first known case of minimally invasive mitral valve surgery for double outlet mitral valve and shows that minimally invasive surgery is extremely impactful in younger patients affected by this congenital disease in shortening their return to baseline function.