Tailored repair of the subvalvular apparatus using 'cut and transfer' technique in patients with chronic ischaemic mitral regurgitation and severe tethering of the mitral leaflets

Abstract

Tethering of both mitral leaflets is the predominant mechanism of mitral regurgitation in patients with chronic ischaemic cardiomyopathy. For patients with severe mitral leaflet tethering, we have developed a surgical approach alternative to the conventional undersized annuloplasty ring that targets the subvalvular apparatus and aims to reconstitute the leaflet coaptation by reducing leaflet tethering in three steps, including the translocation of secondary chordae of the anterior leaflet in primary position, the relocation of the posterior papillary muscle closer to the mitral annulus and the plication of the lateral wall of the left ventricle when a large infarcted area was present. All repairs were completed by a 'true-sized' annuloplasty ring. In this paper, we present the indications, the technical aspects and the initial results of this tailored approach in 53 patients with moderate to severe chronic ischaemic mitral regurgitation and severe leaflet tethering. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.