Left circumflex artery injury postmitral valve surgery, single center experience

Abstract

The left circumflex (LCX) artery is located close to the mitral valve (MV), making it susceptible to injury during MV surgery. We are reporting our experience in the diagnosis and management of this complication. We retrospectively reviewed our surgical and coronary angiography databases for patients with documented LCX artery injury during MV surgery between January 2000 and December 2016. The complication was associated with MV replacement (9/1313, 0.7%) but not MV repair (0/393, 0.0%). Eight patients (88.9%) were female and the mean age was 40.4 ± 14.2 years. There was roughly similar distribution of left and right dominant coronary circulations (5 and 4 patients, respectively). Eight patients (88.9%) had ischemic changes on electrocardiogram and ventricular arrhythmias were documented on six patients (66.7%). Three patients (33.3%) were treated with percutaneous coronary intervention while six patients (66.7%) required redo surgery to graft the LCX artery. The 30-day mortality was high (33.3%). A high index of suspicion is required to diagnose this injury. At the moment, no consensus is available on the optimal treatment strategy. We propose percutaneous approach as the first option to spare the patients from undergoing open-heart surgery for the second time.

Keywords: coronary artery disease; coronary bypass grafts; mitral valve disease; percutaneous coronary intervention; valvular surgery.

Figure 1

Successful percutaneous coronary stenting for patient with LCX injury post-MV surgery after multiple predilatation inflation attempts. LCX = left circumflex; MV = mitral valve. A; diagnostic angiogram, B; PTCA wire crossing the occlusion, C; angiogram post balloon dilation, D; angiogram post stent deployment.