Transaortic repair of mitral regurgitation

In the operative management of mitral regurgitation (MR) associated with aortic valve disease, a transaortic approach combining the bowtie mitral valve repair with replacement of the aortic valve appears to offer a less invasive and technically simple, expeditious alternative to conventional left atriotomy and Carpentier style repair.

Between February 1997 and December 1999, four patients underwent a bowtie repair of the mitral valve via the aortic root with concomitant aortic valve replacement. The diagnosis of MR was established and followed postoperatively by echocardiogram. The operative technique involved a transaortic annular approach to the mitral valve with a single edge-to-edge suture approximating the prolapsing posterior mitral leaflet to a normal segment of the anterior leaflet.

There were no operative mortalities. Mean cross-clamp time for both valve procedures was 104 +/- 24 min and cardiopulmonary bypass was 155 +/- 31. Mean postoperative cardiac output was 5 +/- 1 L/min. Semiquantitative estimation of mitral regurgitation by doppler improved from a mean of 3.2 +/- 0.5 preoperatively to a mean of 0.25 +/- 0.5 (p = 0.0052) postoperatively, while ejection fraction (EF) remained stable (48 +/- 9% preoperatively and 49 +/- 9% prior to discharge). One patient with rheumatic mitral pathology had a mild increased mitral gradient which did not resolve with takedown of the bowtie repair. Mitral stenosis was not evident in any of the other patients.

Our initial experience with the combined transaortic bowtie repair and aortic valve replacement has demonstrated that this approach is very quick, feasible, effective, and technically simple with gratifying midterm results.