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.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine