Posterior Left Ventricular Rupture Following Mitral Valve Surgery: A Literature Review of Successful Repair Strategies

Background Posterior ventricular rupture (PVR) is an uncommon but often fatal complication of mitral valve surgery, with reported incidence between 0.6% and 1.8% and mortality rates approaching 86%. Recognized risk factors include posterior mitral annular calcification, advanced age, female sex, extensive decalcification, and infective endocarditis. Despite advances in surgical techniques, this catastrophic complication continues to pose a major challenge. We reviewed published reports of successful repair strategies to outline practical approaches and propose a management framework. Methods A PubMed search identified 25 reports describing 34 successful repairs of posterior LV rupture. Only cases in which patients survived were included for analysis. Results Most patients (21 of 34) presented with mitral stenosis, usually associated with posterior annular calcification. The circumstances of rupture varied, occurring intraoperatively, during attempts to wean from cardiopulmonary bypass (CPB), or in the intensive care unit. Thirty cases required reinitiation of CPB to enable definitive repair. External repair methods, such as Teflon patch reinforcement and surgical sealants, were reported in 13 patients. Internal approaches most often used pericardial patch reinforcement secured with Teflon‐buttressed sutures, both to restore ventricular integrity and to support the prosthetic valve. In six situations, repair was undertaken using autotransplant techniques on an explanted heart. Mechanical circulatory support was frequently required: 14 patients received intra‐aortic balloon pump therapy, and one patient was supported with an Impella device, both aiming to reduce LV workload during recovery. Conclusion Posterior LV rupture following mitral valve surgery demands immediate recognition and rapid reinstitution of CPB. The choice of repair—internal or external—should be guided by rupture timing, location, and patient stability. Adjunctive mechanical circulatory support can be life‐saving by unloading the injured ventricle. While experience remains limited to isolated reports, systematic accumulation of cases is needed to refine treatment strategies for this highly lethal complication.