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Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
The 'down-under repair' for ischaemic mitral regurgitation
Siew Goh1, Andrew Newcomb1, David Prior2
1Cardiothoracic Department in affiliation with University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Australia.
Heart, Lung & Circulation
|August 17, 2013
Summary
The Down-Under Repair is a novel surgical technique for restrictive ischaemic mitral regurgitation (IMR) that improves mitral valve function. This adjunctive procedure, combined with mitral valve annuloplasty, offers sustained relief for patients with IMR and left ventricular aneurysms.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Heart Valve Repair
Background:
- Restrictive ischaemic mitral regurgitation (IMR) often requires surgical intervention.
- Mitral valve annuloplasty (MVA) with undersized rings is a current approach for leaflet restriction in IMR.
- MVA alone may be insufficient for complete mitral incompetence correction in some IMR cases.
Purpose of the Study:
- To introduce and evaluate the 'Down-Under Repair' as an adjunctive surgical technique for restrictive IMR.
- To address the limitations of MVA alone in specific IMR patient subsets.
- To assess the efficacy of the 'Down-Under Repair' in patients with associated inferobasal left ventricular aneurysm.
Main Methods:
- The 'Down-Under Repair' involves approximating the posterior papillary muscle origin towards the mitral annulus.
- This technique is applied adjunctively to standard mitral valve annuloplasty.
- Midterm clinical outcomes were evaluated in a cohort of patients with restrictive IMR and left ventricular aneurysm.
Main Results:
- The 'Down-Under Repair' effectively reduced mitral leaflet restriction.
- Sustained valvular competence was observed post-procedure.
- Patients experienced significant symptomatic improvement following the combined surgical approach.
Conclusions:
- The 'Down-Under Repair' is a viable adjunctive strategy for managing restrictive IMR.
- This technique offers a solution for patients with IMR and inferobasal left ventricular aneurysms.
- Midterm results indicate sustained functional and symptomatic benefits.
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