TY - JOUR
T1 - 'Bow-tie' mitral valve repair
T2 - An adjuvant technique for ischemic mitral regurgitation
AU - Umana, J. P.
AU - Salehizadeh, B.
AU - De Rose, Jr
AU - Nahar, T.
AU - Lotvin, A.
AU - Homma, S.
AU - Oz, M. C.
AU - Alfieri, O.
PY - 1998
Y1 - 1998
N2 - Background. Current techniques of mitral valve repair rely on decreasing valve area to increase leaflet apposition, but fail to address subvalvular dysfunction. A novel repair has been introduced with partial left ventriculectomy, which apposes the anterior leaflet to a corresponding point on the posterior leaflet creating a double-orifice valve, with reported adequate control of mitral regurgitation. Methods. We started to use the 'bow-tie' repair as an adjunct to posterior ring annuloplasty in cases in which mitral regurgitation was not adequately controlled by decreasing mitral valve area (n = 6), or when placement of an annuloplasty ring was impractical (n = 4). Mean follow-up was 336 days (range, 82 to 551 days) with no postoperative deaths. Results. Mitral regurgitation decreased from 3.6 ± 0.5 to 0.8 ± 0.4 (p < 0.0001), with a concomitant increase in ejection fraction from 33% ± 13% to 45% ± 11% (p = 0.0156) before hospital discharge. Mitral valve area, treasured by pressure half-time, decreased from a meat of 2.5 ± 0.3 to 2.1 ± 0.3 cm2, with a mean transvalvular gradient of 4.5 ± 2.0 mm Hg. In patients whose mitral valve was repaired using the bow-tie alone, mitral regurgitation was reduced from 4+, to a trace to 1+. Postoperatively, mitral valve area increased from 1.9 to 2.5 cm2 during exercise, further supporting the concept that this technique preserves mitral valve annular function. Conclusions. These observations suggest that the bow-tie repair may offer advantages over conventional techniques of mitral valve repair and should be considered as an adjunct, especially in patients with impaired left ventricular function.
AB - Background. Current techniques of mitral valve repair rely on decreasing valve area to increase leaflet apposition, but fail to address subvalvular dysfunction. A novel repair has been introduced with partial left ventriculectomy, which apposes the anterior leaflet to a corresponding point on the posterior leaflet creating a double-orifice valve, with reported adequate control of mitral regurgitation. Methods. We started to use the 'bow-tie' repair as an adjunct to posterior ring annuloplasty in cases in which mitral regurgitation was not adequately controlled by decreasing mitral valve area (n = 6), or when placement of an annuloplasty ring was impractical (n = 4). Mean follow-up was 336 days (range, 82 to 551 days) with no postoperative deaths. Results. Mitral regurgitation decreased from 3.6 ± 0.5 to 0.8 ± 0.4 (p < 0.0001), with a concomitant increase in ejection fraction from 33% ± 13% to 45% ± 11% (p = 0.0156) before hospital discharge. Mitral valve area, treasured by pressure half-time, decreased from a meat of 2.5 ± 0.3 to 2.1 ± 0.3 cm2, with a mean transvalvular gradient of 4.5 ± 2.0 mm Hg. In patients whose mitral valve was repaired using the bow-tie alone, mitral regurgitation was reduced from 4+, to a trace to 1+. Postoperatively, mitral valve area increased from 1.9 to 2.5 cm2 during exercise, further supporting the concept that this technique preserves mitral valve annular function. Conclusions. These observations suggest that the bow-tie repair may offer advantages over conventional techniques of mitral valve repair and should be considered as an adjunct, especially in patients with impaired left ventricular function.
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U2 - 10.1016/S0003-4975(98)00828-5
DO - 10.1016/S0003-4975(98)00828-5
M3 - Article
C2 - 9875764
AN - SCOPUS:0032447207
SN - 0003-4975
VL - 66
SP - 1640
EP - 1645
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -