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Ann Thorac Surg 1995;59:52-55
© 1995 The Society of Thoracic Surgeons

Articles

Mitral valve replacement with complete retention of native leaflets

MD Thomas J. Vander Salm*, MD Linda A. Pape, MD Jonathan F. Mauser

Division of Thoracic and Cardiac Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Accepted for publication June 21, 1994.

* Address reprint requests to Dr Vander Salm, Division of Thoracic and Cardiac Surgery, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA 01655.

Although both mitral leaflets contribute equally to the preservation of left ventricular function after mitral valve replacement, most surgeons routinely excise the anterior mitral leaflet. Possible disadvantages of leaflet retention are left ventricular outflow tract obstruction and interference with prosthetic valve motion. In 31 patients undergoing mitral valve replacement, all mitral valvular and subvalvular tissue was completely retained using a technique that involved reefing the native leaflets into the valve sutures. Fifteen Carpentier-Edwards porcine and 16 St. Jude Medical valves were implanted. Two patients died of causes unrelated to this technique. In the others, echocardiography demonstrated either no or an insignificant left ventricular outflow tract gradient, and, in most, no valvular tissue could be seen in the left ventricular outflow tract. No interference with prosthetic leaflet mobility occurred. The salutary results of mitral valve replacement with complete leaflet retention recommend its use.




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