MO01. Endoscopic Anterior Leaflet Mitral Valve and Tricuspid Repair
IRCCS Policlinico San Donato
Turin, Milan
Italy - Contact Me
Graduated Magna cun Laude at Turin University in November 1985 with a study on Heart Transplantation. Became the youngest Chief Cardiac Surgeon in Italy in 1995 at the age of 35 in a new center in Torino performing 1200 cardiac surgical procedures per year creating the 'Cardioteam' a group of Cardiac surgeons, cardiologists and cardioanestesiologists. The purpose was to put the patient at the center of the terapeutic terapies chosen as team . He performed more than 14.000 cardic procedures including minimally invasive aortic surgery, endoscopic mitral repair, totally arterial myocardial revascularization, aortic sparing procediures: David operation aand aortic valve repair. In 1998 he performed the first videassisted arterial bypass operation through a small minithoracotomy and in 2001 one of the first robotic operation and robotic training for urologists and general surgeons. In 2008 became President of The Cardioteam Foundation, onlus dedicated to prevention, training on cardiovascular terapies on International basis in Romania, Poland, Moldova. From September 2019 he is Chief of Minimally Invasive and Endoscopic Cardiac Surgery Dpt in IRCCS Policlinico San Donato. Milan. Italy.
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.