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Ann Thorac Surg 1999;67:293-294
© 1999 The Society of Thoracic Surgeons

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Correspondence

Leaflet preservation in mitral valve replacement with a tilting-disc valve

^a Cardiac Surgery Service, Hospital de la Santa Creu i Sant Pau, Avenida San AM Claret 167, 08025 Barcelona, Spain

To the Editor

We read with interest the article by Choh [1] about anterior and posterior leaflet preservation with a tilting-disc valve. Several studies underline the benefits of preserving the subvalvular apparatus in mitral valve replacement, but reports of this technique with the use of a tilting-disc valve are scarce [2]. We have been using the recently FDA-approved Monostrut tilting-disc prosthesis (Alliance Medical Technologies, Inc, Irvine, CA) for more than 15 years [3], and since the past 2 years, we have been preserving the posterior leaflet when performing a mitral valve replacement. This initial experience focuses only on posterior leaflet preservation as it has been shown that it decreases postoperative left ventricular end-diastolic pressures and improves exercise capacity [4]. In addition, valve thrombosis and left ventricular outflow obstruction have been described when both anterior and posterior leaflets have been preserved [5, 6].

Our technique differs somewhat from the one described by Choh. After resection of the anterior leaflet, the posterior leaflet is reefed by pledgeted mattress sutures. The sutures enter at the edge of the leaflet and, running under it, exit at the level of the annulus. Thus, the pledgets are left in the ventricular side. The disc is oriented toward the septum, the vertical strut at the 6-o’clock position. Our experience comprises more than 60 cases, including all kinds of valve disease (rheumatic, degenerative, ischemic), with several cases of associated procedures such as aortic valve replacement, De Vega tricuspid annuloplasty, and coronary surgery. No disc impingement or prosthesis dysfunction have been observed.

Doctor Choh should be congratulated for helping to dispel the myth that mitral valve replacement with a tilting-disc prosthesis preserving the subvalvular apparatus is unfeasible and potentially dangerous. His experience, as well as ours, does not support this contention.

References

1. Choh J.H. Preservation of anterior and posterior leaflet in mitral valve replacement with a tilting-disc valve. Ann Thorac Surg 1997;64:271-273.[Abstract/Free Full Text]
2. Feikes H.L., Daugharthy J.B., Perry J.E., Bell J.H., Hieb R.E., Johnson G.H. Preservation of all chordae tendineae and papillary muscle during mitral valve replacement with a tilting disc valve. J Cardiac Surg 1990;5:81-85.[Medline]
3. Aris A., Igual A., Padró J.M., et al. The Spanish Monostrut Study Group: a ten-year experience with 8,599 implants. Ann Thorac Surg 1996;62:40-47.[Abstract/Free Full Text]
4. Horstkotte D., Schulte H.D., Bircks W., Strauer B.E. The effect of chordal preservation on late outcome after mitral valve replacement: a randomized study. J Heart Valve Dis 1993;2:150-158.[Medline]
5. Demirtas M.M. Prosthetic mitral valve thrombosis after replacement with preservation of all chordae. Ann Thorac Surg 1997;63:600-601.[Free Full Text]
6. Esper E., Ferdinand F.D., Aronson S., Karp R.B. Prosthetic mitral valve replacement: late complication after native valve preservation. Ann Thorac Surg 1997;63:541-543.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alejandro Aris Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Aris, A. Articles by Gil Jaurena, J. M. Search for Related Content PubMed Articles by Aris, A. Articles by Gil Jaurena, J. M. Related Collections Related Article