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Transventricular Edge‐to‐Edge Repair of the Mitral Valve During Surgical Ventricular Restoration: Review of the Literature
Author(s) -
Mihos Christos G.,
Santana Orlando,
Lamelas Joseph
Publication year - 2012
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2011.01388.x
Subject(s) - medicine , mitral valve repair , cardiology , ventriculotomy , ventricle , surgery , ischemic cardiomyopathy , coronary artery disease , mitral valve , mitral regurgitation , cardiopulmonary bypass , angina , ejection fraction , myocardial infarction , heart failure
Background: Mitral valve surgery for functional ischemic mitral regurgitation (MR) in high‐risk patients, including those requiring multiple concomitant cardiac operations, carries a significant risk of morbidity and mortality. In patients undergoing surgical ventricular restoration, transventricular edge‐to‐edge repair provides an effective alternative to conventional mitral valve surgery. We report such a case. Methods: A 67‐year‐old male with ischemic cardiomyopathy and severe left ventricular dysfunction presented to our institution with a 3‐month history of dyspnea on exertion, angina, and leg edema. He was found to have triple‐vessel coronary artery disease, a severely dilated left ventricle with an apical aneurysm, and moderate‐to‐severe MR (3+). In addition to coronary artery bypass graft surgery, an edge‐to‐edge mitral valve repair was undertaken via a longitudinal ventriculotomy performed for concomitant surgical ventricular restoration. Results: Total cardiopulmonary bypass and aortic cross‐clamp times were 101 minutes and 86 minutes, respectively. Postoperative transesophageal echocardiography revealed no MR, and the patient was discharged home on postoperative day 9. A follow‐up transthoracic echocardiogram revealed trace MR on postoperative day 15. At 11 months postoperative, the patient remains in New York Heart Association functional class I. Conclusion: Transventricular edge‐to‐edge repair of the mitral valve in patients with ischemic cardiomyopathy and functional MR undergoing SVR is a safe and effective alternative to conventional valve surgery, and should be considered in this high‐risk population. (J Card Surg 2012;27:52–55)