Nonresectional Single-Suture Leaflet Remodeling for Degenerative Mitral Regurgitation Facilitates Minimally Invasive Mitral Valve Repair

Abstract

Background Both leaflet resection and neochordal construction are effective mitral repair techniques, but they may become incrementally time-consuming when using minimally invasive approaches. We have used a single-suture leaflet-remodeling technique of inverting the prolapsed or flail segment tissue into the left ventricle. This repair is straightforward, expeditious, and facilitates a minimally invasive approach. Methods Ninety-nine patients with degenerative mitral regurgitation (MR) underwent a minimally invasive single-suture repair of the mitral valve from May 2007 through December 2012. Preoperative and perioperative echocardiograms as well as patient outcomes were analyzed and compared with those obtained from patients undergoing minimally invasive mitral valve repair using quadrangular resection at the same institution during the same period. Results All 99 patients had a successful mitral repair through a sternal-sparing minimally invasive approach. Ninety-one of the 99 patients had zero MR on postoperative echocardiogram, and 8 of 99 had trace to mild MR. Patients in the nonresectional group had significantly shorter cardiopulmonary bypass and cross-clamp times compared with the quadrangular resection group (115.8 ± 41.7 minutes versus 144.9 ± 38.2 minutes; p < 0.001; 76.2 ± 28.1 minutes versus 112.6 ± 33.5 minutes; p < 0.001, respectively). The mean length of stay was 7.5 ± 3 days. All patients were discharged alive and free from clinical symptoms of MR. There have been no reoperations for recurrent MR on subsequent average follow-up of 1 year. Conclusions An effective, highly efficient, and thus far durable single-suture mitral leaflet-remodeling technique facilitates minimally invasive repair of degenerative MR.

A “Repair-All” Strategy for Degenerative Mitral Valve Disease Safely Minimizes Unnecessary Replacement

“…The minimally invasive MV operations are performed using previously described standardized methods [11][12][13][14][15][16][17].…”

Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease?

“…We opt for central aortic cannulation in patients with significant peripheral arterial disease or atheromata in the descending aorta. As such, we have not noticed an increased risk of stroke when a thoracoscopic approach is employed (7,44). Furthermore, routine utilization of a Chitwood clamp for aortic crossclamping minimizes the risk of iatrogenic aortic dissection from endoaortic balloon occlusion (45).…”

Minimally invasive mitral valve repair in situs inversus totalis

“…Inspection of the mitral valve revealed a ruptured chord to the P2 scallop with fusion and calcification medially (anatomic A3/P3). The flail P2 segment was repaired with a posterior ventricular anchoring neochordoplasty . After inverting the leading edge of the prolapsed segment into the ventricle, the near‐apposing leaflet folds were approximated in a double running fashion with the polytetrafluoroethylene suture that was used to anchor the prolapsed segment.…”