Redo Mitral Valve Replacement in a Patient with Bioprosthetic Valve Dysfunction: A Case Report on Surgical Challenges and Outcomes

Redo mitral valve replacement (Redo-MVR) is a highly challenging surgical procedure, often required to treat dysfunction of bioprosthetic valves resulting from structural valve deterioration (SVD). SVD encompasses a spectrum of pathological changes, including leaflet fibrosis, calcification, and rupture, which compromise valve integrity and function, often necessitating surgical intervention. This case report describes a 48-year-old diabetic female who underwent Redo-MVR for bioprosthetic mitral valve dysfunction following a history of closed mitral commissurotomy and prior bioprosthetic mitral valve replacement. The surgical procedure was marked by challenges such as dense adhesions, complex valve excision, and intraoperative complications, including a tear in the inferior vena cava and right atrial posterior wall. A St. Jude mechanical valve was successfully implanted, with meticulous attention to surgical precision and hemostasis. The patient experienced transient postoperative complications, including atrial fibrillation and hepatic and renal function derangements, which were resolved with appropriate management. At the 30-day follow-up, echocardiography confirmed optimal valve function, with significant improvement in hemodynamic parameters. This case underscores the technical complexities of Redo-MVR, highlights the significance of advanced imaging and surgical planning, and demonstrates the potential for favorable outcomes in high-risk re-operative cardiac surgeries.

Keywords: Redo mitral valve replacement, bioprosthetic valve dysfunction, structural valve deterioration, mitral regurgitation