Percutaneous treatment of left circumflex coronary artery injury related to mitral valve surgery: Case series and systematic review of the literature.
Alice BenedettiGianluca CastaldiEnrico PolettiAlice MoroniBenjamin ScottCarl ConvensStefan VerheyePaul VermeerschPierfrancesco AgostoniCarlo ZivelonghiPublished in: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2023)
Left circumflex coronary artery (LCx) injury related to mitral valve surgery is a rare complication. The best treatment option is not defined, and percutaneous coronary intervention (PCI) may represent an effective treatment to avoid prolonged myocardial ischemia. To evaluate feasibility and efficacy of PCI treatment, all records of LCx injury related to mitral valve surgery and treated with PCI were included after a systematic PubMed searching. Moreover, we retrospectively analyzed our single-center PCI database and patients fulfilling the inclusion criteria were included. Patients undergoing transcatheter mitral valve intervention, non-mitral valve surgery, conservatively or surgically treated after LCx injury were excluded. Data about patient characteristics, procedural details, PCI success, and in-hospital mortality were collected. Fifty-six patients were included, 58.9% were male (n = 33) and the median age was 60.5 years (IQR = 21.75). The majority had left dominant or codominant coronary system (62.2%, n = 28 and 15.6%, n = 7, respectively). Clinical manifestations ranged from hemodynamic stability (21.1%, n = 8) to hemodynamic instability (42.1%, n = 16) and cardiac arrest (18.4%, n = 7). On ECG, 23.5% of patients (n = 12) presented ST-segment depression, 58.8% (n = 30) ST-segment elevation, 7.8% (n = 4) atrioventricular block, and 29.4% (n = 15) ventricular arrhythmias. Left ventricle dysfunction was present in 52.3% (n = 22) of patients and wall motion abnormalities in 71.4% (n = 30). PCI success rate was 82.1% (n = 46) and in-hospital mortality 4.5% (n = 2). LCx injury related to mitral surgery is a rare complication characterized by an increased risk of mortality. PCI seems a feasible treatment option, still burdened by suboptimal results, probably related to the technical challenges posed by the surgical failure.
Keyphrases
- mitral valve
- percutaneous coronary intervention
- end stage renal disease
- coronary artery disease
- coronary artery
- minimally invasive
- acute coronary syndrome
- acute myocardial infarction
- newly diagnosed
- chronic kidney disease
- ejection fraction
- cardiac arrest
- coronary artery bypass
- left ventricular
- st segment elevation myocardial infarction
- st elevation myocardial infarction
- patients undergoing
- antiplatelet therapy
- randomized controlled trial
- atrial fibrillation
- left atrial
- emergency department
- peritoneal dialysis
- cardiovascular disease
- aortic stenosis
- heart failure
- patient reported outcomes
- surgical site infection
- case report
- blood pressure
- depressive symptoms
- machine learning
- physical activity
- high resolution
- transcatheter aortic valve replacement
- big data
- sleep quality
- heart rate variability
- pulmonary artery
- drug induced