Michele D’Alonzo
1* 
, Besart Cuko
2 , Julien Ternacle
2 , Olivier Busuttil
2 , Nabil Dib
2, Serge Sicouri
3 , Carlo De Vincentiis
4 , Louis Labrousse
2 , Thomas Modine
2 , Basel Ramlawi
3,5 , Massimo Baudo
3 1 Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
2 Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
3 Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA
4 Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
5 Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
Abstract
Iatrogenic aortic regurgitation after mitral valve surgery is the consequence of either direct stitching-related perforation or indirect distortion of aortomitral fibrous continuity by the mitral ring/prosthesis. This review aims at describing the reported cases of iatrogenic aortic valve regurgitation following mitral valve surgery, focusing primarily on its management. PubMed, ScienceDirect, DOAJ, and Cochrane databases were searched from inception until December 2023 for case reports and case series describing iatrogenic aortic valve regurgitation following mitral valve surgery. The literature review found 17 articles describing 20 cases of new onset aortic valve regurgitation after mitral valve surgery. Among them, 5 patients did not undergo reoperation, either due to medical decision or patient refusal. The non-coronary cusp was predominantly affected (11 cases), the left coronary cusp involved in 4 cases, and a mixed mechanism occurred in 5 cases. Subsequent surgical interventions included aortic valve replacements in 5 cases and aortic valve repair in 4 cases. A suggested management decision algorithm is finally proposed. Iatrogenic aortic valve regurgitation after mitral valve surgery remains an unfortunate complication. Attention should be given to prevent this complication. Intraoperative transesophageal echocardiography plays a crucial role for early detection. Management strategies vary from medical therapy to surgical interventions. The reparative strategy requires a surgical procedure associated with significant mortality.