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Ann Thorac Surg 1998;66:1640-1645
© 1998 The Society of Thoracic Surgeons

Original Articles: cardiothoracic

"Bow-Tie" mitral valve repair: An adjuvant technique for ischemic mitral regurgitation

Juan P. Umaña, MDa, Bijan Salehizadeh, BAa, Joseph J. DeRose, Jr, MDa, Tamanna Nahar, MDb, Alan Lotvin, MDb, Shunichi Homma, MDb, Mehmet C. Oz, MDa

a Division of Cardiothoracic Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
b Division of and Cardiology, Columbia University College of Physicians & Surgeons, New York, New York, USA

Accepted for publication May 12, 1998.

Address reprint requests to Dr Umaña, c/o Mehmet Oz, MD, Milstein Hospital Building—Division of Cardiovascular Surgery, 177 Fort Washington Ave, 7GN Room # 7-435, New York, NY 10032

Abstract

Background. Current techniques of mitral valve repair rely on decreasing valve area to increase leaflet apposition, but fail to address subvalvular dysfunction. A novel repair has been introduced with partial left ventriculectomy, which apposes the anterior leaflet to a corresponding point on the posterior leaflet creating a double-orifice valve, with reported adequate control of mitral regurgitation.

Methods. We started to use the "bow-tie" repair as an adjunct to posterior ring annuloplasty in cases in which mitral regurgitation was not adequately controlled by decreasing mitral valve area (n = 6), or when placement of an annuloplasty ring was impractical (n = 4). Mean follow-up was 336 days (range, 82 to 551 days) with no postoperative deaths.

Results. Mitral regurgitation decreased from 3.6 ± 0.5 to 0.8 ± 0.4 (p < 0.0001), with a concomitant increase in ejection fraction from 33% ± 13% to 45% ± 11% (p = 0.0156) before hospital discharge. Mitral valve area, measured by pressure half-time, decreased from a mean of 2.5 ± 0.3 to 2.1 ± 0.3 cm2, with a mean transvalvular gradient of 4.5 ± 2.0 mm Hg. In patients whose mitral valve was repaired using the bow-tie alone, mitral regurgitation was reduced from 4+, to a trace to 1+. Postoperatively, mitral valve area increased from 1.9 to 2.5 cm2 during exercise, further supporting the concept that this technique preserves mitral valve annular function.

Conclusions. These observations suggest that the bow-tie repair may offer advantages over conventional techniques of mitral valve repair and should be considered as an adjunct, especially in patients with impaired left ventricular function.




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