Mitral valve replacement in patients after aortic valve replacement

Background: Mitral valve replacement in patients who previously had undergo ne aortic valve replacement is a technical challenge. The rigid aortic pros thesis limits visualization of the anterior mitral annulus and placement of sutures. Methods: Reoperative mitral valve replacement was performed in fi ve patients after aortic valve replacement. Two patients underwent resterno tomy to allow verification of normal aortic prosthetic valve function. Ante rolateral right thoracotomy was used for reentry in the remaining three pat ients. Exposure of the anterior mitral annulus was accomplished by initial traction on the intact anterior leaflet, with resection of this leaflet onl y after placement of sutures. Results: All patients survived the surgical p rocedure and are well 2 to 30 months after operation. In one patient it was impossible to open one cusp of the mitral prosthesis, nor was it possible to rotate the valve. The valve was reimplanted, but sutures were tied only after testing for full free cusp motion. Conclusions.. When appropriate, ri ght thoracotomy incision offers excellent exposure of the mitral valve with minimal dissection. Placement of sutures along the anterior portion of the annulus is facilitated by traction downwards on the anterior leaflet. Full range of motion of the prosthetic cusps should be verified before tying th e sutures.