A novel technique for lead sparing tricuspid valve replacement in the case of a transvenous ICD lead.

Tricuspid valve (TV) surgery represents a complex consideration regarding lead management in patients with a transvenous ICD. The presented case shows favorable short-term results after lead sparing TV replacement, leaving an ICD lead in a paravalvular position. The described technique can be used in challenging cases of TV replacement.

Clinical outcome after mitral valve surgery due to ischemic papillary muscle rupture.

BACKGROUND: Severe mitral regurgitation secondary to papillary muscle rupture is an infrequent but catastrophic complication after myocardial infarction. Without surgical treatment, mortality can reach 80%, but surgical treatment also carries substantial perioperative morbidity and mortality. METHODS: We retrospectively analyzed 28 patients who underwent mitral valve surgery for ischemic papillary muscle rupture. RESULTS: The 30-day mortality rate was 39.3% (11 of 28). There were no significant differences in the baseline characteristics, and concomitant coronary artery bypass (CABG) was performed in 66.7% of the survivor group and in 61.5% of the nonsurvivor group (p = 0.245). Mortality predictors included low cardiac output (p = 0.05), renal failure (p = 0.005), and implementation of extracorporeal membrane oxygenation therapy (p = 0.005). The time between myocardial infarction and surgery showed no significant effects on survival. CONCLUSIONS: Papillary muscle rupture with severe mitral regurgitation carries a high operative mortality. Additional CABG does not influence the acute postoperative course. Postoperative development of low cardiac output with a need for extracorporeal membrane oxygenation therapy and renal failure with hemodialysis substantially reduces survival.