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Universal Repair Technique for Bileaflet and Posterior Leaflet Myxomatous Mitral Valve Regurgitation
Hugh D. Wolfenden, Levi Bassin, Beatrix Weiss.
Prince of Wales Hospital, Randwick, Australia.

OBJECTIVE: We present our results with a repair technique that is objective, simple and reproducible, based on three measurements: normal posterior chord height, size of the anterior leaflet, and set distance from the posterior annulus.
METHODS: This technique was progressively introduced since 2008, with all patients with posterior and bileaflet myxomatous mitral valve disease treated with a standard approach since 2011. Multi (2-5)-headed PTFE neochordal loops were attached to the papillary muscle head(s). The length of the loops was determined by the length of the normal posterior primary chords and attached to the atrial aspect of the posterior leaflet at a standard distance of 1.5cm from the annulus (Figure 1). The neochordae were separated by 6-8mm along the leaflet surface, and attached to any segment taller than 2cm and/or with ruptured/elongated primary chords. The repair was supported with a rigid annuloplasty sized on the anterior leaflet. No leaflet resections were performed. Patients with chordal elongation/rupture to the anterior leaflet were not part of this study.
RESULTS: 87 patients were operated on between 2008 and 2012, 71% male, mean age 67 (38-88 yrs). Isolated posterior leaflet disease was present in 68 and 19 had bileaflet disease. Concomitant procedures included: CABG (n=18), AVR (6), Tricuspid repair (10), and AF surgery (14). In the 30 day post-operative period there was no mortality and one stroke. Post procedure MR grade was ≤mild in all and ≤trivial in 90%. Pre discharge MR was ≤mild in all and ≤trivial in 86%. Recent echocardiographic follow up was available in 71/87 patients with a mean follow up period of 17.1±12.8 months. At follow up MR was ≤mild in 90%, ≤trivial in 62%, and >moderate in one.
CONCLUSIONS: This technique offers a reliable mitral valve repair operation for posterior and bileaflet myxomatous mitral valve regurgitation based on objective measurements, with a standardized and reproducible technique, which is easy to teach. This should allow for more widespread uptake of MV repair, and facilitate minimal access surgery.


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