Ring-first Mitral Valve Repair

Abstract

Mitral valve repair is one of the most frequent interventions in cardiac surgery. It involves eliminating the dysfunctional part(s) of the mitral valve and reconstructing, using the residual tissue or with the addition of prosthetic components, a properly functioning valve, without residual stenosis or regurgitation. A fundamental component of mitral repair is the implantation of a ring (annuloplasty) which reconstitutes the normal, saddle-shaped geometry of the valve. Such ring is usually implanted at the end of the surgical reconstruction regardless of the repair techniques. The implantation of the ring can however change the final anatomy of the valve in an unexpected way and therefore force new corrective surgical actions. We therefore propose a research project that plans the execution of annuloplasty as the first surgical step and then the correction of the valvular disease affecting the leaflets and chordae. The sizing of the ring is always performed on parts of the valve that are usually not changed during the reconstructive surgery, therefore it is possible to decide its size before surgically correcting the valve. In this way we could act on the leaflets and chordae in the definitive geometrical arrangement of the mitral valve.