Rheumatic mitral valve repair: a personal perspective and results

Abstract

Rheumatic mitral valve disease remains a challenge for cardiac surgeons. Valve repair has several advantages over valve replacement but is technically demanding for good results. To improve rheumatic mitral valve repair, surgeons need to have a deep understand of the mitral valve complex and its dynamics. The goal of repair is to restore normal diastolic and systolic function. The current approach is to perform a holistic repair of the entire mitral complex. Each part of the complex is thoroughly explored to define the problem. Several innovative techniques have been introduced to correct valve dysfunction and provide gratifying results. The details of these techniques will be described, based on an understanding of the relationship of the mitral valve complex and dynamics. With this approach, rheumatic mitral valve repair is becoming more successful, reproducible, and safe. Long-term follow-up is mandatory.

Current Perspectives on Contemporary Rheumatic Mitral Valve Repair

“…16 However, resection can be performed on all orders of chordae. 11,15 In our experience, chordal repair is always indicated when the primary chord of the AMVL is resected; chordal transfer or neochordal implantation is performed for anticipatory prolapse upon marginal chordae resection, important in preventing MR which is commonly seen in younger patients if left unrepaired. This is due to the longer linear coaptation-to-hinge distance of the AMVL producing greater tension, hence requiring chordal repair.…”

“…A modified Guiraudon incision provides excellent exposure, which is crucial in successful MVr. 11 Next, Type 1 Carpentier 16 mobility should be reconstructed as best as possible in all leaflet segments to restore…”

“…[6][7][8][9] Although data regarding durability of rheumatic MVr remain contentious, there has clearly been significant improvement in recent years. Reports on contemporary rheumatic MVr have highlighted feasibility and excellent outcomes; [10][11][12][13][14] an overview of several rheumatic MVr series is shown in the Supplemental Table . Chauvaud et al 12 reported 29-year results for isolated MVr in RHD, with a 10-year and 20-year actuarial survival of >80% and 20-year freedom from reoperation of 55%. It should be noted the authors excluded patients with other associated valve lesions and coronary artery disease, but these patients were included in the DiBardino et al series, 1 which found similar survival rates.…”

“…6 - 9 Although data regarding durability of rheumatic MVr remain contentious, there has clearly been significant improvement in recent years. Reports on contemporary rheumatic MVr have highlighted feasibility and excellent outcomes; 10 - 14 an overview of several rheumatic MVr series is shown in the Supplemental Table . Chauvaud et al 12 reported 29-year results for isolated MVr in RHD, with a 10-year and 20-year actuarial survival of >80% and 20-year freedom from reoperation of 55%.…”

“… 4 , 10 , 12 Thus, despite rheumatic MVr being technically and pathologically challenging, many surgeons favor valve reconstruction to be the preferred primary correction. 11 , 12 , 15 …”