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MINIMALLY INVASIVE, VIDEO-ASSISTED REPAIR OF MITRAL VALVE INSUFFICIENCY: SURGICAL STRATEGIES AS A SINGLE CENTER EXPERIENCE
Jan-Philipp Minol, Udo Boeken, Tobias Weinreich, Hildegard Gramsch-Zabel, Payam Akhyari, Hiroyuki Kamiya, Artur Lichtenberg.
University Hospital, Duesseldorf, Germany.

OBJECTIVE: Today, there is great diversity with regard to techniques for repair of organic mitral valve regurgitation. In our department, we use a highly standardized strategy for this pathology.
METHODS: For the prolaps of the anterior leaflet, implantation of neo-chordae (4/0 Gore-Tex) was the technique of choice. Only in case of P2-prolaps with excessive tissue a resection of the leaflet was performed. A sliding plastic was inevitable in cases of calcification of the annulus or high risk for systolic anterior motion. Prolaps of P1 and P3 was always treated with neo-chordae, independent from the size of the segment. This technique was used only for small 2-segments. Cleft closure was an option for residual regurgitation through the cleft or to adjust the height of coaptation to an adjoining segment. For Barlow-patients, P2-resection and chordal transfer from P2 to A2 was performed.
We always use an anuloplasty ring, nowadays mostly an open ring (Medtronic® Future-Band) predominantly to avoid systolic anterior motion. A closed ring (Edwards® Physio-Ring) was used only in the first patients of our series.
RESULTS: Between 8/2009 and 9/2012 we identified 156 patients (77 males, 19 patients with tricuspid valve repair) with mitral valve regurgitation (Carpentier Typ II) from 285 patients undergoing video-assisted minimally-invasive mitral valve surgery via right mini-thoracotomy. Using our standardized strategy, repair rate was 96% in all patients, 87% for the anterior prolaps (15 patients), 99% for the posterior prolaps (106 patients, P2-resection in 37 patients), 82% for the prolaps of the both leaflets (17 patients) and 100% for Barlow-syndrom (16 patients). A closed ring was used in 48 patients (mean size 32.3 ± 1.5 mm) and an open ring was used in 108 patients (mean size 32.7 ± 1.7 mm). Conversion to full sternotomy was necessary in 3 patients (1.9 %) and early mortality was 1.3 %.
CONCLUSIONS: We could show that a reconstruction of an insufficient mitral valve can be performed in the majority of patients in a minimally invasive, video-assisted technique. However, it is necessary to use a standardized strategy with restrictive use of leaflet resection and aggressive use of an open ring.


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