Mitral valve replacement with complete mitral leaflet retention: Operativetechniques

Background and aims of the study: This report describes surgical indication and operative technique of complete preservation of the mitral valvular an d subvalvular apparatus during mitral valve replacement. Methods: Twenty patients, 12 with rheumatic lesions and eight with congenit al lesions, were operated between 1991 and 1996. The left atrium was opened using a trans-septal approach through the right atrium in 17 patients, and at the intra-atrial groove in three. The valve was sized without excising any mitral valvular or subvalvular tissue. Teflon pledget-reinforced horizo ntal mattress valve sutures were passed from the left atrium, through the m itral annulus, around the free edge of mitral leaflet, and up through the p rosthetic sewing ring. The prosthetic valve was seated and the sutures lied , reefing the native leaflets and compressing them between the sewing ring and native annulus. Thus, chordal tension on the ventricle was evenly maint ained. Results: There was no operative or late death. Postoperative results were e xcellent, Echocardiography showed that none of the patients had any observa ble anterior leaflet and redundant subvalvular tissue in the left ventricul ar outflow tract (LVOT); thus, neither LVOT obstruction nor interference wi th prosthetic valve function occurred. Conclusions: Based on these findings, it is suggested that when mitral valv e replacement is required in patients with mitral insufficiency (MI) or MI with mild stenosis, the mitral valvular and subvalvular tissue should be co mpletely preserved.