Combined Mitral Valve Repair with David V Valve Sparing Aortic Root Replacement

MP009 

Case Video Submission 

Patra Childress (1), Sameer Singh (1), Hiroo Takayama (2)

(1) New York Presbyterian, New York, NY, (2) NewYork- Presbyterian/Columbia University Medical Center, New York, NY

Patra Childress    -  Contact Me
New York Presbyterian

Sameer Singh    -  Contact Me
New York Presbyterian

*Hiroo Takayama    -  Contact Me
NewYork- Presbyterian/Columbia University Medical Center

Patra Childress    -  Contact Me
N/A

Title: Combined Mitral Valve Repair with David V Valve Sparing Aortic Root Replacement

Authors: Patra Childress, MD1; Sameer Singh, MD1; Hiroo Takayama MD, PhD1.

1. Division of Cardiothoracic Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY


Objective:
Combined aortic root and mitral valve pathology is uncommon but represents a complex pathology. In select patients, valve sparing aortic root replacement with concomitant mitral valve repair may offer a durable solution while avoiding the risks associated with prosthetic valves. Since 2005, 13 cases of combined mitral valve repair with valve sparing aortic root replacement have been performed at our institution. Median patient age was 64 years, with 92% (12/13) of patients being male. Median cardiopulmonary bypass and cross-clamp time were 198 and 170 minutes, respectively. Mitral valve repair techniques included annuloplasty (84%, 11/13), leaflet resection (31%, 4/13), and artificial chords (31%, 4/13). In-hospital mortality was 8% (1/13) and the incidence of postoperative stroke was 8% (1/13).

Case Video Summary:
This video depicts a case of combined mitral valve repair and David V valve sparing aortic root replacement. The patient was a 73-year-old male who presented with new symptoms of heart failure and was found to have severe mitral regurgitation and aortic insufficiency as well as a 5cm aortic root and ascending aneurysm. Standard median sternotomy with bicaval cannulation was performed. The mitral repair consisted of a quadrangular resection of P2, followed by the use of neochords attached to P3, and a partial annuloplasty ring. Aortic root replacement was performed via the David V reimplantation technique. Special considerations for this combined repair technique include avoiding the use of complete mitral annuloplasty ring, as it may interfere with subsequent root replacement, and oversewing the ascending aorta prior to mitral valve saline testing to allow for accurate assessment.

Conclusions:
Combined mitral valve repair and valve sparing aortic root replacement can be performed safely, although this requires surgeon expertise in both complex aortic and mitral valve repair techniques. Long term follow-up is warranted to further assess the durability of this technique.

Mitral Repair Techniques & Strategies