First Successful Experience of a Novel Prophylactic Surgical Technique to Prevent Ventricular Rupture after MVR

Background: Left ventricular rupture is a lethal complication after challenging mitral valve replacement (MVR).

Method: We present our first experience of a novel prophylactic surgical technique, which we developed in treating challenging MVR after extensive decalcification or debridement of the mitral valve annulus. The technique involves using a modified single pericardial patch to repair the annular defect and to re-establish the connection between the papillary muscles and the annulus, thereby “retethering” the left ventricle.

Results:

Technique:

The size of the posterior annulus is measured with a ring sizer and the distance between the annulus to the papillary muscle heads is recorded. The bovine pericardial patch is then generously fashioned to accommodate the area between the heads of the papillary muscles and the posterior annulus. Each papillary muscle head is attached separately to the Patch with one to two pledget-reinforced sutures. We use the “double pericardial stitch technique” to repair the annular defect and attach the pericardial patch to the posterior annulus. This involves the inversion of horizontal mattress sutures with pledgets beginning on the inner suture line of the pericardial patch. The sutures are then passed intramurally through the defect, the annulus and then again through the outer suture line of the patch in an interrupted manner. Care is taken to keep only light tension between the papillary muscles and the annulus. The free ends of the sutures are then passed through the sewing ring of the prosthetic valve and subsequently are tied down. After confirming satisfactory valve position, the left atrium is closed.

We present a successful series of 14 cases with our technique including schematic drawing, video sequences and echocardiographic results.

Conclusion: Our novel technique can help our colleagues in operating challenging (MVR) with annular abscess or excessive calcification.

Publication History

Article published online:
28 January 2023