A technique to facilitate mitral valve replacement

Replacement of the damaged mitral valve with a biological or mechanical prosthesis occasionally can be difficult. A technique is described that facilitates (a) exposure of the mitral valve, (b) safe excision of the mitral and subvalvular apparatus, (c) good access to the annulus for placement of interrupted sutures in an operative setting that provides good venous return, adequate myocardial protection, and the opportunity for complete removal of air. The procedures described are particularly helpful in reoperative mitral valve surgery when adhesions may limit exposure. The principles have been derived from the need for superb mitral valve exposure during reparative surgery. Perivalvular leak and myocardial rupture have been virtually eliminated by adoption of the principles outlined.