"Bow-tie" mitral valve repair: an adjuvant technique for ischemic mitral regurgitation.
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, measured by pressure half-time, decreased from a mean 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.
Umaña
J P
JP
Division of Cardiothoracic Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA.
Salehizadeh
B
B
DeRose
J J
JJ
Nahar
T
T
Lotvin
A
A
Homma
S
S
Oz
M C
MC
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications; D005260:Female; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications