Abstract:

The long-term outcomes of undersizing annuloplasty for the treatment of ischemic mitral regurgitation (IMR) is affected by the progressive dilation of the annulus, which carries increased risk for ring disinsertion. Reasons underlying this phenomenon might be found in the excess of physical stress on the annuloplasty sutures during the ventricular remodeling process. We report a technique based on the placement of a double row of overlapping sutures aiming at reducing the potential for ring disinsertion. Eleven patients with IMR undergoing mitral valve repair associated with coronary bypass grafting were treated with this technique and echocardiographically followed up at 6 and 12 months. The overall annular dimension decreased significantly with a significant reduction of the tenting area and no recurrence of mitral regurgitation at 1 year. A double row of overlapping sutures allowed firm attachment of the prosthetic ring while downsizing the annulus in IMR, limiting the consequences of changes in subannular ventricular geometry. This technique might therefore be considered a useful aid during mitral valve repair.

Authors:

Francesco Nappi, MD, PhD, Consultant Cardiac Surgeon, Centre Cardiologique du Nord, St. Denis, France, Cristiano Spadaccio, MD, PhD, Consultant Cardiac Surgeon, Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy, Nawwar Al-Attar, PhD, FRCS, FETCS, Consultant Cardiac Surgeon, Golden Jubilee National Hospital, Clydebank, United Kingdom, Massimo Chello, MD, Full Professor of Cardiac Surgery, Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy, Mario Lusini, MD, PhD, Consultant Cardiac Surgeon, Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy, Raffaele Barbato, MD, Consultant Cardiac Surgeon, Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy, Christophe Acar, MD, Professor of Cardiac Surgery, Department of Cardiac Surgery, Hopital La Pitie Salpetriere, Paris, France

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