Loop Technique Mitral Repair With Flexible Exposure System
Toshihiko Shibata, Takashi Murakami, MD, phD, Hiromichi Fujii, MD, phD, Yosuke Takahashi, MD, phD, Akimasa Morisaki, M, phD, Yoshito Sakon, MD, Sinsuke Nishimura, MD, Kokoro Yamane, MD.
Osaka City University, Osaka, Japan.
OBJECTIVE: Loop technique mitral valve repair is good for minimally invasive surgery. We made some instruments for comfortable procedure.
METHODS: We made a measuring rod, a workbench for making loop set and a special atrial retractor for expanding the left atrial wall from inside. This trans-working port retractor system consists of flexible bar made by 99.9% tin and the retracting instrument with a blade and shaft(figure). The tin bar is 0.65mm in depth and has many dips on the surface to prevent slipping. The tin bar is easily bended and stretched using the forceps, so we can put the fold tin bar into the heart via small skin incision, and can expand it for the shape as we want. The measure the length between the papillary muscle head to the leaflet edge, and desired number of the loops were made according to the length. Each loop was fixed to the leaflet edge with 5-0 polypropylene suture with double passing fashion. If we need longer length of loop, the loop was extended with another EPTFE suture using loop-in-loop technique. Ink dot marking was useful for ensure the coaptation depth.
RESULTS: We had done 360 mitral valve repair with loop technique in nine years, and the successful rate was 99%. We move to minimally invasive video surgery using 3D endoscope in recent 30 cases. The exposure of the mitral valve was satisfactory using this flexible exposure system.
CONCLUSIONS: These tips enable us to get good repair rate in loop technique.
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