Feasibility of preservation of subvalvular apparatus in mitral valve replacement with the On-X mechanical valve

Abstract

ration of suture material, technical mistakes, or acute infection. Surgical intervention to repair the leak improves symptoms of heart failure, decreases the need for blood transfusion, and is an independent predictor of long-term survival when compared with medical therapy alone. The choice of operation involves either direct suture repair of the PVL or rereplacement of the valve and is indicated to correct worsening left ventricular function or symptoms of heart failure and hemolysis. Although surgical intervention has been the gold standard for the repair of PVLs, there has been a growing interest in the attempt to close PVLs through the use of interventional cardiologic techniques. Several reports have documented the successful percutaneous repair of PVLs with closure devices similar to those applied for the percutaneous treatment of septal defects. Percutaneous closure has several advantages, including the elimination of the risk of a redo operation and shortening the length of hospital stay. Nevertheless, the procedure is complex, time consuming, and not always successful, as illustrated in this case. Successful intraoperative device closure of muscular ventricular septal defects has previously been reported. However, to our knowledge, the case presented herein is the first reported use of the intraoperative placement of a percutaneous occluder device for the surgical repair of a PVL. This novel approach for the repair of a mitral PVL can be applied in the context of extremely difficult mitral prosthesis exposure, such as the presence of a concurrent aortic prosthesis, or to avoid lengthy redo operations in very high-risk patients.