MITRAL-VALVE REPAIRS USING THE POSTERIOR TRICUSPID LEAFLET AND CHORDAE - TECHNIQUE AND RESULTS

Objective. Some mitral lesions are still out of reach of conventional repairs. Transferring the posterior leaflet of the tricuspid valve wit h its subvalvular apparatus to the mitral valve is a new autograft tec hnique which has allowed us a conservative approach in cases where rep air seemed less predictable. Methods. After removing the posterior tri cuspid leaflet with its subvalvular apparatus, the tricuspid autograft was inserted by implanting its papillary muscle onto the mitral papil lary muscle and then by suturing the leaflet tissue in place. The tric uspid valve was subsequently repaired by annular plication and leaflet suture. A tricuspid ring was used in all but the first case. Results. The age of the seven patients ranged from 20 to 70 years. Postoperati ve controls by transesophageal echocardiography showed no leaks in fiv e and trivial in one on the site of the mitral repair. On the tricuspi d valve, we found a moderate leak in the first case and trivial or non e in the following cases, where a tricuspid ring was used. With a 3-12 month follow-up the results are stable. Conclusions. This autograft t echnique is reproducible, and extends the field of mitral valve repair s. Compared to segments of mitral homografts, we prefer the intraopera tive availability of natural chordae and valvular leaflet that have no immunological interference. The patient is his own tissue bank and th e tricuspid valve can be repaired with a very low risk of significant dysfunction.