Robotic "haircut" mitral valve repair: posterior leaflet-plasty

Posterior leaflet prolapse has been repaired traditionally by leaflet resection with or without a sliding annuloplasty. However, substantial annular calcification, thin leaflets, or deficient P1 or P3 scallops can complicate this technique. Annular closure after large posterior leaflet resection introduces substantial radial stress even in the presence of a sliding annuloplasty. We describe a novel technique that corrects posterior leaflet prolapse, minimizes leaflet resection, and preserves posterior leaflet-annulus continuity. This reconstructive technique can be applied in traditional mitral valve repairs but is suited particularly to the robotic approach, in which enhanced visualization and dexterity make the "haircut" repair easy to perform.