Concomitant Replacement of the Aortic, Mitral, and Tricuspid Valves

MP011 

Case Video Submission 

Philip Coffey (1), John Kuckelman (1), Robert Rice (1), Richard Lee (1)

(1) Augusta University Medical Center, Augusta, GA

Philip Coffey    -  Contact Me
Augusta University Medical Center

John Kuckelman    -  Contact Me
Augusta University Medical Center

Robert Rice    -  Contact Me
Augusta University Medical Center

*Richard Lee    -  Contact Me
Augusta University Medical Center

Philip Coffey    -  Contact Me
N/A

Objective:
To present our operative approach to a complex case with high mortality and how we minimize pump time and clamp time.

Case Video Summary:
We present a concomitant aortic valve replacement, mitral valve replacement, and tricuspid valve replacement in a 69 year old female with severe mitral regurgitation, severe tricuspid regurgitation, and moderate aortic insufficiency. We begin the case with a median sternotomy and bicaval venous cannulation. We then cross clamp, give antegrade, place an LV vent, and divide the aorta while giving retrograde cardioplegia. We excise the native aortic valve then give handheld antegrade cardioplegia. We then proceed to the mitral valve replacement. The chords of the anterior leaflet were too short and thickened to preserve, but we did preserve the posterior leaflet. We then replace the aortic valve, close the aorta, and remove the cross clamp. We then perform a tricuspid valve replacement beating heart. We close the right atrium, wean from bypass, and decannulate.

Conclusions:
In a case of this magnitude with high mortality, minimizing cross clamp time is critical and we believe this approach minimizes both bypass time and clamp time while providing optimal cardiac protection.

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