Transaortic repair of mitral regurgitation

Background: In the operative management of mitral regurgitation (MR) associ ated with aortic valve disease, a transaortic approach combining the bowtie mitral valve repair with replacement of the aortic valve appears to offer a less invasive and technically simple, expeditious alternative to conventi onal left atriotomy and Carpentier style repair. Methods: Between February 1997 and December 1999, six patients underwent a bowtie repair of the mitral valve via the aortic root with concomitant aort ic valve replacement. The diagnosis of MR was established and followed post operatively by echocardiogram. The operative technique involved a transaort ic annular approach to the mitral valve with a single edge-to-edge suture a pproximating the prolapsing posterior mitral leaflet to a normal segment of the anterior leaflet. Results: There were no operative mortalities. Mean crossclamp time for both valve procedures was 104 +/- 24 min and cardiopulmonary bypass was 155 +/- 31. Mean postoperative cardiac output was 5 +/- 1 L/min. Semiquantitative estimation of mitral regurgitation by doppler improved from a mean of 3.2 /- 0.5 preoperatively to a mean of 0.25 +/- 0.5 (p = 0.0052) postoperativel y, while ejection fraction (EF) remained stable (49 +/- 9% preoperatively a nd 48 +/- 9% prior to discharge). One patient with rheumatic mitral patholl ogy had a mild increased mitral gradient which did not resolve with takedow n of the bowtie repair. Mitral stenosis was not evident in any of the other patients. Conclusions: Our initial experience with the combined transaortic bowtie re pair and aortic valve replacement has demonstrated that this approach is ve ry quick, feasible, effective, and technically simple with gratifying midte rm results.