1. The 'respect rather than resect' principle in mitral valve repair: The lateral dislocation of the P2 technique
- Author
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Samer Kassem, Gabriella Ricciardi, Laura Cavallotti, Paolo Poggio, Marco Zanobini, Matteo Saccocci, Francesco Liborio Mammana, Alessandro Di Minno, Zanobini, Marco, Ricciardi, Gabriella, Mammana, Francesco Liborio, Kassem, Samer, Poggio, Paolo, Di Minno, Alessandro, Cavallotti, L., and Saccocci, Matteo
- Subjects
respect than resect ,Male ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,mitral reparation ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Resection ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,P2 prolapse ,law ,Posterior leaflet ,mitral surgery ,Mitral valve ,medicine ,Cardiopulmonary bypass ,Humans ,Aged ,Mitral regurgitation ,Mitral valve repair ,mitral prolapse ,P2 dislocation ,Cardiopulmonary Bypass ,business.industry ,Cardiopulmonary Bypa ,Lateral dislocation ,General Medicine ,Middle Aged ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,Female ,mitral regurgitation ,business ,Cardiology and Cardiovascular Medicine ,Human - Abstract
Background Leaflet resection represents the reference standard for surgical treatment of mitral valve (MV) regurgitation. New approaches recently proposed place emphasis on respecting, rather than resecting, the leaflet tissue to avoid the drawbacks of the 'resection' approach. Objectives The lateral dislocation of mid portion of mitral posterior leaflet (P2) technique for MV repair is a nonresectional technique in which the prolapsed P2 segment is sutured to normal P1 segment. Our study evaluates the effectiveness of this technique. Patients and methods We performed the procedure on seven patients. Once ring annular sutures were placed, the prolapsed P2 segment was dislocated toward the normal P1 segment with a rotation of 90° and without any resection. If present, residual clefts between P2 and P3 segments were closed. Once the absence of residual mitral regurgitation is confirmed by saline pressure test, ring annuloplasty was completed. The valve was evaluated using transesophageal echocardiography in the operating room and by transthoracic echocardiography before discharge. Results At the last follow-up visit, transthoracic echocardiography revealed no mitral regurgitation and normal TRANSVALVULAR gradients. Conclusion The lateral dislocation of P2 is an easily fine-tuned technique for isolated P2 prolapse, with the advantage of short aortic cross-clamp and cardiopulmonary bypass times. We think it might be very favorable in older and frail patients. Long-term follow-up is necessary to assess the durability of this technique.
- Published
- 2017