Emergency operation of redo second and third mitral valve regurgitation in a patient with a history of the mitral valve prosthesis, coronary artery bypass graft surgery, and moderate aortic regurgitation: a case presentation

Redo cardiac surgery is usually more complex than initial surgery and has a higher risk of mortality due to the risks associated with sternotomy.Thoracotomy is a procedure through which easy access to the heart and valves is possible, taking less time. There is no need to release the adhesions of the previous operation. In addition, there is no possibility of heart rupture and unstable hemodynamics in the second CABG operation.Safe peripheral Cardiopulmonary bypass (CPB) access and right thoracotomy are preferred in patients with unstable hemodynamics with a history of CABG and mitral valve replacement (MVR) surgery.A 60 -year old man with a history of prosthetic MVR, CABG, and right-hand paresis due to cerebrovascular accident (CVA) was referred to Madani Hospital in Tabriz, Iran (2020). Transthoracic echocardiography (TTE) revealed signs of severe dysfunction of the prosthetic mitral valve (PMV). Whereas, on anticoagulation, a left ventricular ejection fraction (LVEF) was about 40%, and the patient had mild to moderate aortic regurgitation (AI). The patient underwent an emergency redo MVR operation using the thoracotomy techniques and coronary intervention (hybrid procedure). After two weeks, TTE showed a decreased mobility of one PMV leaflet, and the patient did not respond to full anticoagulation. Therefore, the third surgery was performed.