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

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 cm: with a mean transvalvular gradient of 4.5 +/- 2.0 mm Hg. In patients whose mitral valve was repaired using the bo-cv-tie alone, mitral regurgitation was reduced from 4+, to a trace to 1+. Postoperatively, mitral valve area increased from 1.9 to 2.5 cm(2) during exercise, further supporting the concept that this technique preserves mitral valve annular function. Conclusions. These observations suggest that the bowtie 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. (C) 1998 by The Society of Thoracic Surgeons.