Mitral valve repair was one of the first operations performed on the heart. In 1923 Elliot Cutler performed a successful valvotomy for mitral stenosis.1 Though this was a destructive rather than a reconstructive procedure, it nevertheless is the first representation of the concept behind mitral valve repair—to use the patients own valvular tissue to create a functional, durable treatment for the affecting disease process. When valve prostheses were developed the surgeon’s attention was temporarily diverted from repair. Prostheses were easier to place and required less ischemic time.
However, the early enthusiasm for bioprostheses was tempered by their limited life span. Enthusiasm for mechanical prostheses was tempered by the requirement for anticoagulation. A few pioneers continued to develop and refine techniques and demonstrated that repair led to lower failure rates with a lower incidence of thromboembolism, hemorrhage, and infection.
This book was conceived to foster and promote the application of repair techniques in mitral surgery. Because busy surgeons do not have much spare time we aimed for brevity.
The stated goal at the outset was not to recommend, but instead to review and assess the wide variety of techniques surgeons have applied over the years to treat different problems.
The book is organized based on techniques that address problems with specific valve components, attempting to present a number of solutions for similar problems. Since static diagrams often do not transfer well to the operating room we have included six complete annotated videos to supplement the text. However, unlike many video presentations, we have broken these up into specific segments with references within the text.
1. The Natural History of Mitral Regurgitation
2. Functional Anatomy of the Mitral Valve
3. Pathology of Mitral Valve Disease
4. Assessing the Functional Substrate of Mitral Regurgitation with Echocardiography
5. Overview of Mitral Valve Repair
6. Annuloplasty: Sutures, Bands, and Rings
8. Anterior Leaflet Repair Techniques
9. Posterior Leaflet Repair Techniques
10. Commissural Repair Techniques
11. Other Techniques
12. Complications and Assessing the Quality of Repair
Title: Atlas of Mitral Valve Repair
Authors: EDWARD B. SAVAGE, STEVEN F. BOLLING