Transaortic Repair of Mitral Regurgitation

Abstract

Background: In the operative management of mitral regurgitation (MR) associated 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 conventional 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 aortic valve replacement. The diagnosis of MR was established and followed postoperatively by echocardiogram. The operative technique involved a transaortic annular approach to the mitral valve with a single edge-to-edge suture approximating the prolapsing posterior mitral leaflet to a normal seg-ment of the anterior leaflet.

Results: There were no operative mortalities. Mean cross-clamp 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) postoperatively, while ejection fraction (EF) remained stable (49 ± 9% preoperatively and 48 ± 9% prior to discharge). One patient with rheumatic mitral pathollogy had a mild increased mitral gradient which did not resolve with takedown of the bowtie repair. Mitral stenosis was not evident in any of the other patients.

Conclusions: Our initial experience with the combined transaortic bowtie repair and aortic valve replacement has demonstrated that this approach is very quick, feasible, effective, and technically simple with gratifying midterm results.