Clinical experience of surgical repair left ventricular rupture after mitral valve replacement

Background: Left ventricular rupture after mitral valve replacement is very rare but often leads to death. This study aimed to report one center experience. Methods: Retrospective case series from 2001 to 2021 at the Heart Institute. Results: There had 18 cases of left ventricular rupture after mitral valve replacement (0.2%). 94% of patients were female, the mean age at surgery was 57. Rheumatic mitral stenosis (11) or mitral disease (6) occurred in the majority of cases. 6/18 has posterior annulus calcification; 3/18 cases had reoperation after previous mitral valve replacement. The median valve size was 27 (25-29mm). Type I rupture 03; type II: 1 and type III: 14. Time of left ventricular rupture occurrence: early in 5; late in 2 and intermediate in 11 cases. The mortality rate was 61% (11/18). Regarding the repair technique, 8 cases of external repairs, without opening the heart and 10 cases of combined internal and external repairs, reinforced with bio-glue. 100% had supported by extracorporeal circulation and 15/18 cases had inserted intra-aortic balloon counterpulsation. Conclusion: preserve the posterior valve as much as possible, gentle resection of the diseased valve, and no need for radical decalcification of the posterior annulus are measures to prevent left ventricular rupture. The combined technique of internal and external repairs with bio-glue coating has shown a good hemostatic and high success rate.