Nonresectional Simplified Folding Technique in Robotic Mitral Valve Plasty: Comparison with Leaflet Resection Technique
Objective: The mitral valve plasty (MVP) technique for degenerative disease is typically leaflet resection and suturing. However, this technique is time consuming and unreproducible. To overcome this disadvantage, we developed a nonresectional folding technique, which is fast and reproducible. In this report, we examine our new folding technique in
Methods: The new folding technique was performed in 10 patients (age 56 ± 15 years), and the conventional resection and suturing (RS) technique was performed in 22 patients (age 53 ± 8 years). In our new folding technique, we used two sutures to fold the prolapsed leaflet to the left ventricle side. The first folding suture line is a land mark, and the second line adjusts the height of the posterior leaflet to the anterior leaflet so that sufficient coaptation depth can be obtained.
Results: MVP was successful in all patients. In the folding technique group, the operation time, cardiopulmonary bypass time, and cross clamp time was faster than the conventional RS technique group (188 ± 31, 97 ± 32, and 55 ± 3 min, versus 242 ± 51, 137 ± 25, and 70 ± 15 min; P < .05). Hospital stays were significantly shorter in the folding technique group (13 ± 2 days versus 17 ± 7 days; P < .05). All patients were discharged without complications. The post-echocardiography revealed no mitral valve regurgitation in any patient.
Conclusion: The new folding technique facilitated efficient MVP for posterior leaflet prolapse in mitral valve regurgitation, without the need for the resection of the leaflet.
Carpentier A. Cardiac valve surgery—the ‘‘French correction.’’ 1983. J Thorac Cardiovasc Surg 86:323-37.
Chitwood WR, Rodriguez E, Chu MWA, et al. 2008. Robotic mitral valve repairs in 300 patients: a single-center experience. J Thorac Cardiovasc Surg 136:436-41.
Mihaljevic T, Blackstone EH, Lytle BW. 2006. Folding valvuloplasty without leaflet resection: simplified method for mitral valve repair. Ann Thorac Surg 82: e46-8.
Ramzy D, Trento A, Cheng W, et al. 2014. Three hundred robotic-assisted mitral valve repairs: the Cedars-Sinai experience. J Thorac Cardiovasc Surg 147:228-35.
Suri RM, Burkhart HM, Daly RC, et al. 2011. Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: establishing the benchmark against which percutaneous interventions should be judged. J Thorac Cardiovasc Surg 142:970-9.
Suri RM, Dearani JA, Mihaljevic T, et al. 2016. Mitral valve repair using robotic technology: safe, effective, and durable. J Thorac Cardiovasc Surg 151:1450-4.
Suri RM, Taggarse A, Burkhart HM, et al. 2015. Robotic mitral valve repair for simple and complex degenerative disease: midterm clinical and echocardiographic quality outcomes. Circulation 132:1961-8.
Tabata M, Ghanta RK, Shekar PS, et al. 2008. Early and midterm outcomes of folding valvuloplasty without leaflet resection for myxomatous mitral valve disease. Ann Thorac Surg 86:1388-90.
Tsukui H, Umehara N, Saito H, et al. 2013. Early outcome of folding mitral valve repair technique without resection for mitral valve prolapse in 60 patients. J Thorac Cardiovasc Surg 145:104-8.
Watanabe G, Ishikawa N. 2015. Use of barbed suture in robot-assisted mitral valvuloplasty. Ann Thorac Surg 99:343–5.
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