Subannular Technique To Correct A Severe Iiib Mitral Regurgitation: A Minimally-invasive Fully Endoscopic Approach
Evaldas Girdauskas, MD, Lenard Conradi, MD, Eva Harmel, MD, Ulrich Schäfer, Johannes Petersen, MD, Stefan Blankenberg, MD PhD, Hermann Reichenspurner, MD PhD.
University Heart Center Hamburg, Hamburg, Germany.
OBJECTIVE: Pathophysiological background of functional mitral regurgitation (FMR) is a progressively increasing distance between papillary muscle tips and mitral annular plane. Standard surgical FMR treatment (i.e., Carpentier type IIIb dysfunction) by means of undersized mitral annuloplasty is associated with a high recurrence rate. Although subannular techniques have been suggested to improve surgical results, none of them have been implemented systematically or in a minimally-invasive surgery setting.
METHODS: We propose a simple and reproducible subannular maneuver to correct FMR while combining standard mitral annuloplasty with a controlled realignment of both papillary muscles, thereby fixing the distance between mitral annular plane and papillary muscle tips, which may be easily used in a minimally-invasive fully endoscopic mitral valve surgery setting (Figure 1).
RESULTS: We present the surgical technique of minimally-invasive mitral valve repair performed due to severe Type IIIb mitral valve insufficiency which includes subannular maneuver to realign both papillary muscles (i.e., feasibility study). The first 10 patients with severe FMR (i.e., LVEF < 40%) who underwent this procedure at our institution showed no in-hospital mortality and pre-discharge echocardiography demonstrated no residual (or only trivial) MR.
CONCLUSIONS: Our initial experience indicates that adding of this subannular maneuver to the standard annuloplasty during minimally-invasive mitral valve surgery and thereby fixing the distance between papillary muscles and mitral annular plane has a potential to improve results of surgical FMR treatment.
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