Mitral Valve Repair for Failed MitraClip: a Case Report / 日本心臓血管外科学会雑誌

The patient was an 89-year-old male who underwent transcatheter edge-to-edge repair to the mitral valve using MitraClip for severe degenerative mitral regurgitation (MR) one year earlier. Although two clips were implanted, grade III/IV MR still remained. As his heart failure progressed, he was referred to us for surgery. The patient also had aortic stenosis. He underwent mitral valve repair and aortic valve replacement. The postoperative course was uneventful. He was transferred to the referring hospital on postoperative day 14. When performing MitraClip for degenerative MR, it is important to consider carefully not only the operative risk for open surgery but also the anatomical adequacy of MitraClip. When MitraClip fails to control MR, early surgical intervention should be considered.

Comprehensive Pain Control Strategy in Minimally Invasive Mitral Valve Repair.

PURPOSE: The effect of our comprehensive strategy to reduce pain after minimally invasive mitral valve repair through a right mini-thoracotomy was assessed retrospectively. METHODS: Our comprehensive strategy constituted the following: planned rib cutting to avoid rib injury, sufficient intercostal muscle division to mobilize the cut rib, limiting the number of intercostal ports, avoiding nerve entrapment, continuous extra-pleural intercostal nerve block, and regular use of oral non-steroidal anti-inflammatory drugs. We compared patients treated with this comprehensive strategy (Group S, n = 13) and patients before this strategy was implemented (Group C, n = 13). We used a numerical rating scale (NRS) as a pain scale during the first 3 days postoperatively. RESULTS: The average NRS was significantly lower in Group S (0.82 ± 0.49) than in Group C (2.40 ± 1.46) (P <0.01). The maximum NRS was also significantly lower in Group S (3.23 ± 1.17) than in Group C (5.69 ± 2.43) (P <0.01). The number of patients using additional single-dose analgesic were significantly less in Group S (23.1%) than in Group C (84.6%) (P <0.01). CONCLUSION: Our comprehensive pain control strategy effectively reduced postoperative pain in minimally invasive mitral valve repair.

Use of VIABAHN Stent Graft for Subclavian Artery Injury due to Inadvertent Catheter Placement / 日本心臓血管外科学会雑誌

A 77-year-old man presenting with uremic acidosis was referred to our department for a misplaced vascular access catheter. Computed tomography revealed the catheter was passing through the subclavian artery and terminating in the ascending aorta. Under angio-fluoroscopic monitoring, a VIABAHN stent graft was deployed immediately after removing the catheter. The patient had no hemorrhagic complication although continuous hemodiafiltration was started just after surgery. His postoperative course was uneventful.