When too much closeness harms: circumflex artery injury during mitral valve surgery

Christian Dumps; Philipp Simon; Evaldas Girdauskas; Felix Girrbach

doi:10.3389/fcvm.2023.1183182

When too much closeness harms: circumflex artery injury during mitral valve surgery

Front Cardiovasc Med. 2023 Oct 27:10:1183182. doi: 10.3389/fcvm.2023.1183182. eCollection 2023.

Authors

Christian Dumps¹, Philipp Simon¹, Evaldas Girdauskas², Felix Girrbach¹

Affiliations

¹ Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany.
² Department of Cardiothoracic Surgery, University Hospital Augsburg, Augsburg, Germany.

Abstract

Occlusion of the left coronary circumflex artery (LCX) during surgical procedures of the mitral valve is an infrequent but potentially life-threatening complication (1-3). Due to its close anatomical relationship to the posterior mitral valve annulus, there is a relevant risk of causing a stenosis or an occlusion of the left circumflex artery, especially by surgical annular sutures. The perioperative clinical course is heterogeneous, ranging from-initially-asymptomatic or solely electrocardiographic abnormalities to cardiogenic shock. Both severely impaired ventricular contractility or malignant arrhythmia may potentially lead to a weaning failure from cardiopulmonary bypass (CPB) and eventually result in chronic heart failure with persistently reduced ejection fraction. Possible therapeutic strategies include the immediate reopening of causal sutures, aortocoronary bypass grafting or percutaneous coronary intervention (PCI), yet PCI seems to be the preferred method at present.

Keywords: cardiac surgery; coronary occlusion; heart valve prosthesis implantation; minimally invasive surgery; mitral valve; mitral valve insufficiency; valvular annuloplasty.

Publication types

Review