Initial Clinical Experience With Mitral Valve Translocation for Secondary Mitral Regurgitation

How To Do It: Mitral Valve Translocation

“…MVT was developed as a durable repair solution for patients with SMR. MVT was introduced into the clinic 21 as an alternative treatment strategy for patients in whom traditional RMA was expected to have a suboptimal result. The procedure is not particularly complex and is similar to MV replacement with the addition of a second running suture line.…”

Mitral Valve Translocation: A Novel Approach to Repair Secondary Mitral Regurgitation

“…16 While RMA is generally effective in reducing MR at the time of operation, it achieves this reduction with minimal coaptation enhancement 17,18 and leaves the patient at risk of recurrent MR should ventricular enlargement and further leaflet restriction develop. In contrast, the supranormal coaptation achieved after MVT (14 ± 2 mm) 8 is protective against MR recurrence, as shown in early follow-up of patients undergoing MVT, with a sustained median coaptation length of 14 mm through 1 year and no recurrence of moderate or greater MR.…”

“…12 Clinical experience has demonstrated MVT, performed with autologous pericardium briefly treated with 0.625% glutaraldehyde, to be safe and effective. In the initial clinical experience, 8 there was no operative mortality, stroke, or renal failure, and all patients left the operating room with no/trace MR and a median mean gradient of 3 mm Hg. The mean coaptation length was 14 mm.…”

Secondary mitral regurgitation repair techniques and outcomes: Initial clinical experience with mitral valve translocation

“…We have developed a novel operative approach to address all of the pathophysiologic mechanisms of FMR, termed MV translocation ( Figure 1 ; Video 1 ). 33 In MV translocation, the native MV is excised circumferentially within 1-2 mm of the annulus, leaving the commissures and subvalvular apparatus intact, and the insertion of a 1 cm frustum-shaped patch translocates the intact native valve into the ventricle, thereby improving coaptation. MV translocation creates circumferential augmentation of the MV leaflet, which creates a generous and supranormal surface of coaptation.…”

“…The first MV translocation was performed in 2018 (Institutional Review Board approval HP-00076929 33 ). Early in the experience, the size of the patch was individualized based on intraoperative annular measurements, but eventually uniform dimensions were chosen so as to achieve a standard 100-mm atrial circumference and 110-mm ventricular circumference.…”