Flip-over for Mitral Valve Repair without Heterologous Material in a Reintervention for Failed Previous Repair with Heterologous Patch: is it possible?

MO010 

Case Video Submission 

Luca Zanella (1), Stefano Mastrobuoni (2), Gaby Aphram (2), Alain Poncelet (2), Geoffroy De Beco (2), Gébrine El Khoury (2), Laurent de Kerchove (2)

(1) Cardiac Surgery Unit, Cliniques Universitaires Saint-Luc (UCL) and University of Padova, Brussels, Belgium and Padova, Italy, (2) Cardiac Surgery Unit, Cliniques Universitaires Saint-Luc (UCL), Brussels, Belgium

Luca Zanella    -  Contact Me
Cardiac Surgery Unit, Cliniques Universitaires Saint-Luc (UCL) and University of Padova

Stefano Mastrobuoni    -  Contact Me
Cardiac Surgery Unit, Cliniques Universitaires Saint-Luc (UCL)

Gaby Aphram    -  Contact Me
Cardiac Surgery Unit, Cliniques Universitaires Saint-Luc (UCL)

Alain Poncelet    -  Contact Me
Cardiac Surgery Unit, Cliniques Universitaires Saint-Luc (UCL)

Geoffroy De Beco    -  Contact Me
Cardiac Surgery Unit, Cliniques Universitaires Saint-Luc (UCL)

*Gébrine El Khoury    -  Contact Me
Cardiac Surgery Unit, Cliniques Universitaires Saint-Luc (UCL)

*Laurent de Kerchove    -  Contact Me
Cardiac Surgery Unit, Cliniques Universitaires Saint-Luc (UCL)

Luca Zanella    -  Contact Me
N/A

Objective: Mitral valve repair should be the first choice in severe mitral valve insufficiency. Avoiding heterologous material in leaflet repair could be better, especially in young patients. The aim of this case presentation is to show that mitral valve repair without using heterologous material on leaflets is also possible in reintervention for failed post-endocarditis mitral repair.
Case video summary: A 29 years old man presented with severe mitral insufficiency five years after Staphylococcus Aureus endocarditis, treated by mitral valve repair with heterologous patch on the anterior leaflet, between A2 and A3 areas according to Carpentier's classification. Recently, the patient experienced dyspnea and echocardiography revealed a severe mitral insufficiency (regurgitation volume 97 milliliters) and dilatation of left ventricle (end systolic diameter 65 millimeters) with a preserved ejection fraction (64%).
A reintervention was performed: the mitral valve presented a big cleft on the anterior leaflet between A2 and A3, where the previous patch was placed; in contrast, it seemed to be disappeared. A triangular resection of P2 was performed and the gap sutured with a continuous 4/0 polypropylene suture. By using the flip-over technique the resect tissue was a patch for the anterior leaflet, sutured with two continuous 4/0 polypropylene sutures between A2 and A3. Secondary order chordae were cut, and posterior papillary muscle was split, to improve the leaflet motion. Moreover, an annuloplasty with a semi-rigid ring of 30 millimeters of diameter was done with 2/0 braided polyester sub-annular single stitches. Total bypass time for procedure was 84 minutes and total cross clamp time 71 minutes. The heart had a perfect recovery from extracorporeal circulation and transesophageal echocardiography showed a good result of mitral repair. The man had an excellent post-operative recovery. In addition, echocardiography at discharge and at follow-up confirmed a good result of mitral repair.
Conclusions: This case showed a good result of mitral valve repair without heterologous material for the leaflets, in reintervention for failed previous mitral repair with a heterologous patch for endocarditis. This kind of repair should be the first choice especially for young patients, to avoid heterologous material deterioration or endocarditis recurrence, also in reinterventions. Further studies are required to verify the long-term outcome of this kind of repair.