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Mitral Valve Regurgitation Due To Bileaflet Prolapse: Physiological Correction Through A Totally Video-Guided Approach
tommaso hinna danesi, giovanni domenico cresce, loris salvador.
Ospedale San Bortolo Vicenza, Vicenza, Italy.

OBJECTIVE: Mitral valve regurgitation (MVR) due to bileaflet prolapse (BP) is one of the most complex lesion to be treated by reconstructive surgery. In the present study we report our operative results in the management of BP-MVR using a physiological repair and a minimally invasive totally video-guided approach.
METHODS: From January 2010 to November 2013, 601 patients underwent Totally Video-Guided Port-Access Cardiac Surgery at our Institution. Among them, 506 (84%) received a mitral valve repair. A degenerative pathology underlying a severe mitral regurgitation was the indication for surgery in 409 cases; among them 78 (19%) patients (50 male; mean age 59.4 ± 16.1 years) had a BP-MVR.
Fourteen patients (17.8%) were in NYHA functional class III or IV. The technique utilized to repair the MVR was the e-PTFE neo-chordae implantation completed with a posterior annuloplasty using a flexible band. Associated procedures were: tricuspid valvuloplasty in 4 cases (5%), AFib radiofrequency ablation in 14 pts (18%) and a PFO closure in 34 pts (43.5%).
RESULTS: Mean CBP time and x-clamp time were 148 ± 53 and 107 ± 52 min respectively. There was no in-hospital mortality. We had no conversion to conventional sternotomy, reoperation for bleeding and aortic dissection. We achieved the mitral valve repair in all cases. Six patients (7.6%) required an edge-to-edge stitch to avoid systolic anterior motion (SAM) of the anterior MV leaflet. Postoperative complications were: new atrial fibrillation onset in 6 patients (7.6%), atrio-ventricular block requiring permanent pacing in 2 patients (2.5%). No major neurological events were observed. At discharge postoperative echocardiogram showed mild residual MVR in 2 (2.5%) cases, due to mild SAM without left ventricular outflow obstruction.
CONCLUSIONS: Our results showed the effectiveness of the respect-than-resect technique in the treatment of MVR due to BP. The reduction of leaflets remodeling maneuvers is particularly useful with a completely video-guided thoracoscopic MV approach.

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