Back to 2024 Display ePosters
Endoscopic MVR-Total Chorde Preservation Is Better Option
Lalitaditya Malik, Mch( CTVS);
Manipal Hospital, jaipur, India
Abstract cardiac surgery on the mitral valve access can be in different ways: through right anterolateral thoracotomy and via median sternotomy. Median sternotomy remains the most common approach for mitral valve procedures, such as replacement or repair, allowing good visualisation, exposure and working field. Enhanced understanding of surgical technique and technological development led to the breakthrough of a minimally invasive approach for mitral valve surgery, which offers several advantages, such as less postoperative pain, lower morbidity and mortality, faster recovery, and shorter hospital stay. In an effort to share our institutional experience of less invasive surgery, this paper demonstrates our approach to mitral valve replacement with total chorde preservation through a right minithoracotomy in the 3rd or 4th intercostal space. When repair is not feasible, the preservation of left ventricular function is an important concern.Surgical Technique & VideoAnesthesiaAnesthesia is provided according to the standard protocol used for a conventional mitral replacement. We usually use a single lumen normal tube for intubation. A double lumen endotracheal tube can be used for single (left) lung ventilation if some difficulties during preparation are expected. Pleural adhesions, in case of reoperation.. . The mitral valve is exposed through a classic left atriotomy. The anterior mitral valve leaflet (AML) is slit open in the middle between the two main groups of chordae at the 12 o'clock position of the mitral valve. Multiple slits are now made into the posterior mitral valve leaflet (PML), starting at the midportion of the P2 segment followed by additional cuts into the P1 and P3 segments, in order to ensure enough space for an adequate or even larger sized prosthetic valve.DiscussionThe eversion of leaflets allows the anterior and posterior chordae to fall away from the disc of the prosthesis. We have to be cautious to adjust the tension on the chordae during eversion and avoid too much stress on them.ConclusionThis technique thus ensures the mitral annular-papillary muscle continuity during mitral valve replacement and minimizes the potential risks, complications, and complexities of several other techniques.
Back to 2024 Display ePosters
