Tailored repair of the subvalvular apparatus using 'cut and transfer' technique in patients with chronic ischaemic mitral regurgitation and severe tethering of the mitral leaflets.
Tethering of both mitral leaflets is the predominant mechanism of mitral regurgitation in patients with chronic ischaemic cardiomyopathy. For patients with severe mitral leaflet tethering, we have developed a surgical approach alternative to the conventional undersized annuloplasty ring that targets the subvalvular apparatus and aims to reconstitute the leaflet coaptation by reducing leaflet tethering in three steps, including the translocation of secondary chordae of the anterior leaflet in primary position, the relocation of the posterior papillary muscle closer to the mitral annulus and the plication of the lateral wall of the left ventricle when a large infarcted area was present. All repairs were completed by a 'true-sized' annuloplasty ring. In this paper, we present the indications, the technical aspects and the initial results of this tailored approach in 53 patients with moderate to severe chronic ischaemic mitral regurgitation and severe leaflet tethering.
Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy.
Giampiero
G
Esposito
Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy giangi_cappabianca@libero.it.
Giangiuseppe
G
Cappabianca
Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy.
Samuele
S
Bichi
Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy.
Davide
D
Patrini
D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D017202:Myocardial Ischemia
Ischaemic mitral regurgitation; Leaflet tethering; Mitral repair