Alternative approaches for mitral valve repair

Abstract

Unique situations arise in which alternative exposures for mitral valve surgery offer distinct advantages over traditional approaches. Each exposure facilitates both mitral valve repair and replacement, although the standard repair procedures must be modified to accommodate these non-traditional exposures. Here, we detail the technical considerations required to perform transventricular and transaortic mitral valve repair as well as discuss the advantages for employing these less conventional approaches.

Keywords: Mitral valve repair; transaortic; transventricular.

Figure 1

Transventricular exposure of mitral valve using an off pump coronary stabilizer.

Figure 2

Mitral annuloplasty sutures are first placed circumferentially through the annuloplasty ring.

Figure 3

With careful attention to avoid entanglement with chordae tendineae, the needles from the annuloplasty sutures are then passed through the mitral annulus from the atrial side to the ventricular side and out through the ventriculotomy.

Figure 4

After circumferential placement of annuloplasty sutures through the mitral annulus, the ring is lowered through the mitral valve orifice to the atrial side of the annulus.

Figure 5

Annuloplasty sutures are tied with the knots resting the ventricular side of the annulus.

Figure 6

Following debridement of infected tissue, the mitral valve is easily viewed through the aorta.

Figure 7

Annuloplasty sutures are first placed in the posterior mitral valve annulus.

Figure 8

The posterior aspect of the annuloplasty ring is tied onto the posterior annulus. Sutures that were placed through the anterior aspect of the ring emanate out through the aortotomy.

Figure 9

The annuloplasty sutures in the anterior ring are brought through the pericardial patch to reconstruct the aortomitral junction.

Figure 10

The pericardial patch is sewn to the coapting portion of the anterior mitral leaflet to complete the reconstruction of the mitral valve.