Second cross-clamping after mitral valve repair for degenerative disease in contemporary practice†

Abstract

In a large volume centre for mitral repair, a second cross-clamping is still performed in 3-5% of the patients. Because suboptimal immediate results are associated with impaired late outcomes of mitral reconstruction, a low threshold for a second cross-clamping seems to be justified. If the second repair is carried out with a relatively shorter additional cross-clamping time, mortality and morbidity are not increased and immediate and long-term results are very satisfactory.

Del Nido cardioplegia: Questions and (some) answers

“…We do know that a second crossclamp period is not uncommon, particularly in valve repair cases. Alfieri's and colleagues 11 published a report of 2318 patients undergoing mitral repair showing that 4.2% required a second crossclamp period, mostly for residual mitral regurgitation or systolic anterior motion, but the cardioplegia strategy was not described. Second crossclamp times tend to be shorter, as evidenced by the median of 23 minutes in Alfieri and colleagues' report.…”

Commentary: Mitral valve re-repair: Rejection of imperfection

“…In their retrospective review, El-Ashmawi and colleagues 1 corroborate several previous studies that suggest that a second and perhaps even a third attempt at correcting less than moderate residual mitral regurgitation (MR) identified by intraoperative transesophageal echocardiography (TEE) after initial repair is generally safe when tempered with clinical judgment. [2][3][4] This persistence toward perfection to eliminate even mild mitral insufficiency appears further justified by evidence that achieving trace to no residual MR benefits long-and perhaps even short-term clinical outcomes. 5,6 This study offers additional insight.…”

Using Position‐Based Dynamics for Simulating Mitral Valve Closure and Repair Procedures

“…Surgical reconstruction is the gold standard therapy for MR with often times very good long‐term results [SBF*08, SSB*14]. However, there are reports indicating that assistance may be required to improve the success rate in MV repair [GCTP02, BLG*18, GCB*02]. Gammie et al .…”