Mitral valve repair: The Manipal alternative

Background and aim of the study: An easily reproducible, rational and durable method of repairing the incompetent mitral valve, which does not require complex chordal procedures or the use of an expensive prosthesis and long-term anticoagulation, remains a desirable goal. Here, we describe such a method that has been developed at our institute. Methods: The step-wise repair comprises: (i) preparation of a ring from a 3 x 110 mm strip of Dacron felt covered with untreated autologous pericardium; (ii) mitral commissurotomy and mobilization of the subvalvular apparatus, when required; (iii) infolding of the small portion of flail unsupported mitral leaflet, when present, by interrupted stitches; (iv) anchoring of the pre-prepared ring to the mitral annulus with interrupted horizontal mattress sutures, the sutures on the posterior annulus stopping short of the commissures by 12-15 mm and on the anterior annulus by 8-10 mm; (v) excision of the unanchored portions of the ring opposite the commissures, leaving behind 76-84 mm of the anchored parts; (vi) placement of two 'U-on-side' pericommissural annuloplasty sutures passed through the cut ends of the incomplete ring, then through the respective annulus, and finally emerging near the anterolateral and posteromedial commissures; and (vii) tying off the two periommissural sutures over Teflon pledgers. Results: Between January 1988 and December 1997, the technique was used to repair 107 mitral valves. Among 90 patients who had mitral valve repair alone or combined with tricuspid or aortic valve repair, only one hospital death occurred. One patient required reoperation due to an unacceptable degree of hemolysis. Among survivors followed up from one to >10 years, 80% were in NYHA functional class I, and 70% did not have clinical mitral regurgitation. Conclusion: This alternative technique of mitral valve repair is simple to perform, and relatively inexpensive. It provides gratifying results in acquired mitral valve disease, as well as in mitral valve prolapse subjects, and the repaired valve appears to function well, even after 10 years.