# Iatrogenic aortic valve injury following mitral valve surgery: A systematic review

## TL;DR

This paper reviews cases of aortic valve injury caused by mitral valve surgery and discusses management strategies to address this rare but serious complication.

## Contribution

The study provides a systematic review and proposed management algorithm for iatrogenic aortic valve regurgitation following mitral valve surgery.

## Key findings

- Seventeen articles describing 20 cases of iatrogenic aortic valve regurgitation following mitral valve surgery were identified.
- Non-coronary cusp was predominantly affected in 11 cases, with surgical interventions including aortic valve replacements and repairs.
- Intraoperative transesophageal echocardiography is emphasized for early detection of this complication.

## 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.