Roll up your sleeves, roll up your retractor, and repair the mitral valve

Abstract

Central MessageTo continue to advance the field of mitral valve repair surgery, better visualization aids are needed. This new retractor can help the surgeon see the papillary muscles for chordal replacement.See Article page 643. To continue to advance the field of mitral valve repair surgery, better visualization aids are needed. This new retractor can help the surgeon see the papillary muscles for chordal replacement. See Article page 643. In their article in this issue of the Journal, Tudorache and Haverich1Tudorache I. Haverich A. Enhanced exposure of subvalvular structures during mitral valve repair with a novel flexible and reusable leaflets retractor.J Thorac Cardiovasc Surg. 2018; 156: 643-645Abstract Full Text Full Text PDF Scopus (3) Google Scholar have described a flexible and reusable mitral valve leaflet retractor for better exposure of the subvalvular structures during a mitral valve repair that requires neochord construction. They are to be congratulated for their innovation and work to advance the field of cardiac surgery. This innovation comes in a long line of progress in mitral valve surgery. The earliest mitral valve surgery was done without any visualization of the valve, with a knife through the apex or with a finger through an atriotomy. Thousands of patients benefited from blind commissuroplasty for many years. Later, with the invention of the cardiopulmonary bypass machine, new techniques to fix the mitral valve were described, with visualization and reconstruction of the valve. Fifty years ago, the invention of mechanical mitral valves by Starr and Edwards spurred growth again in options for mitral valve disease treatment, and mitral valve replacement became a preferred treatment option. In 1983, the seminal article by Carpentier, “The French Correction,” changed the understanding and treatment of mitral valve disease and inspired many surgeons to adopt repair techniques (instead of replacement) in standard practice. Today, after confirmation of better outcomes by many investigators (relative to valve replacement), the accepted treatment for degenerative mitral valve disease revolves around repair of the valve, including leaflet resection and chord replacement. The development of minimally invasive techniques has further advanced the field, allowing patients to undergo mitral valve repair through a small incision or entirely through tiny port-access holes. These small access surgical holes make the creation of a diminutive retractor (which can roll into a scroll and be placed through a port) even more important. Surgeons need to see the mitral valve and subvalvular apparatus to replace chords, and doing so through a tiny hole can be difficult. This retractor can help. The advance from blind mitral surgery to mitral valve replacement to preferred mitral valve repair brings with it the need for better instrumentation and novel devices and approaches to improve the techniques and make it easier for all surgeons to repair the mitral valve successfully. Making the papillary muscles easier to see with this novel retractor is another step in the evolution of better surgery. Tudorache and Haverich1Tudorache I. Haverich A. Enhanced exposure of subvalvular structures during mitral valve repair with a novel flexible and reusable leaflets retractor.J Thorac Cardiovasc Surg. 2018; 156: 643-645Abstract Full Text Full Text PDF Scopus (3) Google Scholar are to be applauded for their continued work to advance the field of mitral valve repair. Enhanced exposure of subvalvular structures during mitral valve repair with a novel flexible and reusable leaflets retractorThe Journal of Thoracic and Cardiovascular SurgeryVol. 156Issue 2PreviewIn degenerative mitral valve surgery, mitral valve repair can be performed with very low mortality (<1%) and offers a postoperative survival similar to the expected age- and sex-adjusted general population.1 An important step of the valve reconstruction involves removal of the pathologic leaflet segment and/or resuspension of the loose leaflet segment on an adequate papillary muscle with the use of artificial chordae.2 Exposure of the papillary muscles, particularly through a minimally invasive approach, can sometimes be challenging, especially in cases characterized by excess of leaflet tissue. Full-Text PDF Open Archive