Mitral Valve Repair

Mitral valve repair is shown to have better survival, preservation of ventricular function and decreased thromboembolic complications compared to mitral valve replacement for mitral regurgitation (MR).13–15 At our institution, we have developed a simple algorithm for mitral valve repair in myxomatous disease, which allows reproducible and durable repair. Our general plan is described by the following steps: 1. Assess the valve after opening the left atrium through Sondergaard’s groove. A saline test is used, as well as a preoperative transesophageal echocardiogram (TEE), to find the exact etiology and pathologic malformation. 2. Perform a standard repair technique to the most obvious lesion causing regurgitation (eg, quadrangular resection to the posterior leaflet.) 3. Use the height of the anterior leaflet to measure and place a prosthetic annuloplasty ring. 4. Test the valve after the ring placement and repair any residual lesions if needed. We believe that over 90% of the valves will be repaired using this algorithm, even for the bileaflet prolapsed valve. Coordination with cardiac anesthesia colleagues is the key, with TEE images providing more accurate anatomic valve etiology allowing surgeons to plan the repair strategies prior to opening the left atrium, and following separation from cardiopulmonary bypass.