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OBJECTIVE:
Mitral valve repair techniques for degenerative disease generally focus upon leaflet resection and reconstruction, which are highly effective and proven methods that can be time consuming and may predispose to monoleaflet function, systolic anterior motion (SAM), and even dynamic mitral stenosis. We have utilized and report here a simplified leaflet-remodeling technique of inverting a small portion of the diseased leaflet tissue into the left ventricle to eliminate prolapse without the need for resection. This repair is straightforward, expeditious and is particularly well-suited to facilitate minimally-invasive operations.
METHODS:
72 patients with degenerative mitral regurgitation (MR) underwent a single suture plication repair of the mitral valve through a 3cm chest incision. The leading edge of the prolapsed segment of the mitral valve was grasped and inverted into the left ventricle which was then imbricated with a double running CV 5 suture, resulting in a smooth plane of coaptation. Preoperative and perioperative echocardiograms as well as patient outcomes were analyzed.
RESULTS:
All 72 patients had a successful mitral repair via a sternal sparing minimally invasive approach. 66 of the 72 patients had no mitral regurgitation on postoperative echocardiography, while 6 of the 72 patients had 1⁺MR. There were no conversions to an open repair. The mean length of stay was 7 ± 3days. Mean follow up was 1 year, with an average MR grade of 0.4.
CONCLUSIONS:
An effective and highly efficient mitral leaflet remodeling technique has been utilized to repair degenerative disease and has been successfully applied in 72 patients using a minimally invasive approach.