1. Mitral Valve Implantation
Donald D. Glower, MD 
Operative Techniques in Thoracic and Cardiovascular Surgery 
Volume 5, Issue 4, Pages (November 2000)
DOI: /2000.otct.16251
Copyright © 2000 Elsevier Inc. Terms and Conditions

2. 1
The anterior leaflet of the mitral valve is detached from the annulus, carrying the incision through each of the commissures. The anterior leaflet is split into two halves between the insertions of the anterior and posterior chordae.
Operative Techniques in Thoracic and Cardiovascular Surgery 2000 5, DOI: ( /2000.otct.16251)
Copyright © 2000 Elsevier Inc. Terms and Conditions

3. 2
The body of the anterior leaflet and any bulky tissue are then resected from each half of the anterior leaflet, leaving only the primary anterior chordae and the leading edge of the anterior leaflet segments.
Operative Techniques in Thoracic and Cardiovascular Surgery 2000 5, DOI: ( /2000.otct.16251)
Copyright © 2000 Elsevier Inc. Terms and Conditions

4. 3
If necessary, the posterior leaflet may be split to the annulus between the insertions of the anterior and the posterior chordae. A bulky posterior leaflet may be detached from the annulus and debrided, leaving only the primary posterior chordae attached to the leading edge of the leaflet. The mitral annulus is debrided of calcium only as needed for secure placement of annular sutures.
Operative Techniques in Thoracic and Cardiovascular Surgery 2000 5, DOI: ( /2000.otct.16251)
Copyright © 2000 Elsevier Inc. Terms and Conditions

5. 4
Extensive annular debridement may require reconstruction of the mitral annulus with pericardium, taking care to not narrow the circumflex artery or the coronary sinus posteriorly.
Operative Techniques in Thoracic and Cardiovascular Surgery 2000 5, DOI: ( /2000.otct.16251)
Copyright © 2000 Elsevier Inc. Terms and Conditions

6. 5
Horizontal mattress sutures with supra-annular pledgets are placed circumferentially around the mitral annulus, using traction on previous sutures to expose the annulus as necessary.
Operative Techniques in Thoracic and Cardiovascular Surgery 2000 5, DOI: ( /2000.otct.16251)
Copyright © 2000 Elsevier Inc. Terms and Conditions

7. 6
The two posterior leaflet segments, if detached, are then secured to the posterior annulus by bringing the posterior sutures through the leading edge of the remaining leaflet.
Operative Techniques in Thoracic and Cardiovascular Surgery 2000 5, DOI: ( /2000.otct.16251)
Copyright © 2000 Elsevier Inc. Terms and Conditions

8. 7
Similarly, the two anterior leaflet segments, if detached, are then secured to the anterior annulus by bringing the anterior sutures through the leading edge of the remaining leaflet.
Operative Techniques in Thoracic and Cardiovascular Surgery 2000 5, DOI: ( /2000.otct.16251)
Copyright © 2000 Elsevier Inc. Terms and Conditions

9. 8
Sutures are placed through the prosthesis sewing cuff. Bioprostheses should be oriented so that the struts do not obstruct the left ventricular outflow tract.
Operative Techniques in Thoracic and Cardiovascular Surgery 2000 5, DOI: ( /2000.otct.16251)
Copyright © 2000 Elsevier Inc. Terms and Conditions

10. 9
The annulus is inspected for potential perivalvular leaks, which are secured with horizontal mattress sutures as necessary.
Operative Techniques in Thoracic and Cardiovascular Surgery 2000 5, DOI: ( /2000.otct.16251)
Copyright © 2000 Elsevier Inc. Terms and Conditions