The double-orifice technique in mitral valve repair: A simple solution for complex problems (original) (raw)

2001, The Journal of Thoracic and Cardiovascular Surgery

The aim of this study is to report our results with the central doubleorifice technique used for the treatment of complex mitral valve lesions. Methods: The central double-orifice repair has been used in 260 patients (mean age, 56 ± 14.3 years) over a period of 7 years. The mechanism responsible for mitral regurgitation was prolapse of both leaflets in 148 patients, prolapse of the anterior leaflet in 68, prolapse of the posterior leaflet with annular calcification or other unfavorable features in 31, and lack of leaflet coaptation for restricted motion or erosion of the free edge in 13. Degenerative disease was the cause of mitral regurgitation in 80.8% of the patients, rheumatic disease was the cause in 9.6%, endocarditis was the cause in 6.1%, and ischemic disease was the cause in 2.3%. Results: Hospital mortality was 0.7%, and the overall survival at 5 years was 94.4% ± 2.59%. Thirteen patients required a reoperation (2 early postoperatively and 11 late during the follow-up), for an overall freedom from reoperation of 90.0% ± 3.37% at 5 years. Freedom from reoperation was lower in patients with rheumatic valve disease and in patients who did not undergo an annuloplasty procedure. Conclusions: The effectiveness and durability of the central double-orifice technique were assessed in this study. This type of repair can be a useful addition to the surgical armamentarium in mitral valve reconstruction. R epair of a regurgitant mitral valve is superior to mitral valve replacement, with lower hospital mortality, longer survival, better preservation of ventricular function, fewer thromboembolic complications, and reduced risk of endocarditis. 1 Therefore, it is desirable to extend the population of patients who can benefit from mitral valve reconstruction. The most common cause of degenerative mitral regurgitation (MR) is a floppy (myxomatous) valve with segmental prolapse of the posterior leaflet. 2 This lesion can be corrected by means of quadrangular resection of the prolapsing portion of the posterior leaflet, with highly reproducible and durable results. 3 Other lesions, however, are associated with less-gratifying results, require more complex and surgically demanding techniques, or both, and many surgeons are hesitant to perform a reconstructive operation under these circumstances. For instance, correction of MR caused by anterior leaflet prolapse is less predictable than posterior leaflet repair, and the poor results obtained with anterior leaflet resection have led to other more complex and less reproducible techniques, such as chordal shortening, chordal transposition, and chordal replacement. 4-8 Similarly, prolapse of both leaflets in severe myxomatous degeneration