MO01. Endoscopic Anterior Leaflet Mitral Valve and Tricuspid Repair
IRCCS Istituto Policlinico San Donato,
SAN DONATO MILANESE, Milan
Italy - Contact Me
Graduated in 1985 Magna cum Laude at the University of Turin with thesis on Heart Transplant. At ther age of 35 became de youngest Chief Cardiac Surgeon in Italy in a Center performing 1.200 cardiac surgery procedures/year in Turin. Since 2008 President of The Cardioteam Foundation Onlus for prevention, teaching and treatment of Cardiovascular Diseases in Italy and International programs in Romania, Moldavia, Egypt and Georgia.
Since 2019 is Chief Of Minimally Invasive and Endoscopic Surgery at IRCCS Policlinico San Donato. Milan
Consultant for Endoscopic Cardiac Surgery at ' Centre Cardio-thoracique de Monaco' Montecarlo.
He has accomplished more than 14.000 cardiac operation as firsr surgeon, total arterial coronary revascularization, Mitral and tricuspid valve repair mininvasive and endoscopic, Minimally invasive aortic valve surgery, aortic valve sparing procedure and TAVI .
Description
Case Video Summary: A 68 years old patient presented with a worsening mild dyspnea (class NYHA II) and severe mitral and tricuspid regurgitation at trans-thoracic echocardiography. Trans-esophageal Echocardiogram confirmed the presence of severe anterior mitral prolapse, with first order chordae tendinae rupture of A2 scallop and associated flail. After a peripheral arterial and single venous double stage femoral cannulation, Del Nido anterior cardioplegia is infused, after clamping the aorta with Cygnet clamp through a 6 centimeters anterior-lateral incision in the III right intercostal space. Left atrium is opened and a venting line is positioned to keep the field clear. Valve inspection confirms transesophageal echocardiographic findings, associated with clearly thinned chordae tendinae of A3 scallop and concomitant mild prolapse. A 5/0 Goretex artificial chorda tendinea is positioned on the free edge of A2 and the damaged native chorda tendinea is resected; its length is adjusted comparing the length of the native ones. A 5/0 Goretex suture is positioned on the free edge of A3 where the secondary mild prolapse is found, in order to reduce the length of the free margin. A 34 complete prostetic mitral annulus is positioned and no resection of the anterior leaflet is performed. Left atrium is closed with a double running 4/0 Prolene suture and right atrium is opened to perform tricuspid valve annuloplasty with a flexible 32 prosthetic tricuspid ring, without encircling superior and inferior venae cavae. Intraoperative hydrodynamic test showed good continence after repair.
Conclusions: AL prolapse has been considered a more challenging problem and long-term results are not usually as favourable as those for PL prolapse. Many surgical techniques are currently available for the treatment of AL prolapse, involving not only the leaflets but also the subvalvular apparatus. Complex mitral valve repair is feasible even in totally minimally invasive endoscopic CT surgery, with optimal visualization of all the mitral valve apparatus. Even trcuspid valve repair is feasible with a simplified technique: single venous double stage cannulation without encircling venae cavae.