FEASIBILITY STUDY OF A MECHANICAL SUTURING DEVICE FOR LESS INVASIVE MITRAL OPERATIONS

Background. Because of smaller incisions and limited exposure, less in vasive operations on the mitral valve can be arduous and time-consumin g. This study examined the feasibility of a mechanical suturing device to facilitate less invasive mitral replacement. Methods. Five mongrel dogs underwent limited left thoracotomy. After conventional cardiopul monary bypass and cardioplegia, the mitral valve was exposed through a left atriotomy. After excision of the anterior leaflet, subannular su tures were placed using a mechanical suturing device. This device simu ltaneously passes two ends of a pledgeted 2-0 braided suture through t he valvular annulus, then mechanically grasps both needles on the atri al aspect. Hence, a mattress suture is accomplished one-handed in a si ngle continuous motion. This procedure was repeated around the entire annulus. A mechanical valve was seated and the sutures were tied and c ut. Results. All mechanical valves were implanted successfully. In the 4 animals in which it was attempted, cardiopulmonary bypass was succe ssfully weaned. No evidence of perivalvular leak was observed by echoc ardiography. Conclusions. These data establish the feasibility of a me chanical suturing device for operations on the mitral valve. The devic e is easily mastered, maintains precise spacing between sutures, and p ermits rapid placement of mattress sutures. We predict widespread appl ication for both less invasive and conventional valve operations.