1. How to Do A Mitral Valve Repair for Rheumatic Valve Disease
Taweesak Chotivatanapong, MD.
AATS 2015: Adult Cardiac Skills Course
25th April 2015
Seattle, USA.
Department of CVT Surgery, Central Chest Institute of Thailand
Nonthaburi, Thailand.

2. Goals of MV Repair
To restore normal mitral dynamics BOTH Diastole and Systole.

3. Focus :
Rheumatic : MS MR
: MS

4. Severe MS with Large LA Clot

5. Severe MS with very severe Subvalvular Fibrosis

6. Severe Calcified MS

7. MS MR Post PBMV

8. Long Term Fate of Autologous Pericardium

9. Rheumatic Mitral Valve Repair : Current Approaches and Results at Central Chest Institute of Thailand
Taweesak Chotivatanapong, MD.

10. Between March 2003 – June ♦ 420 patients : RHD MV repair ♦ MR : 157 , MS MR : 178 , MS : ♦ F : M : 149 , AV age : y

11. Follow up : Range : 11 Y 3 m – 1 m Lost FU: 22 patients
Mean : Overall : m
MR : m
MS MR : m
MS : m

12. Overall
Pre-op Post-op LVEDD LVESD EF MR MVA NYHA FC Technique P.O Mean gradient Max gradient 9.11

13. MR
Pre-op Post-op LVEDD LVESD EF MR MVA NYHA FC Technique PO . Mean gradient Max. gradient 7.08

14. MS MR
Pre-op Post-op LVEDD LVESD EF MR MVA NYHA FC Technique PO. Mean gradient Max. gradient 9.32

15. MS
Pre-op Post-op LVEDD LVESD EF MR MVA NYHA FC Technique PO. Mean gradient Max. gradient

16. Operations : MV repair = 137 MV repair + TV repair = 95
MV repair + MAZE =
MV repair + TV repair + MAZE =
MV repair + AVR + TV repair =
MV repair + AVR =
MV repair+ CABG =
MV repair+ TV repair + ASD =
MV repair + Other =

17. Results : Hospital mortality = 8 (1.9% )
Late death : 6 ; 3 cardiac, 3 non-cardiac
Readmission
- Pericardial effusion
- CHF
- Coumadin overdose 8
- Severe MR
- Transient CVA

18. Reoperation :
- Redo MVR
- Redo MV re-repair

19. Current MV Repair Strategy
Restore sinus rhythm
Restore mobility :
- Type I
- 3 dimensional movements
-Up& down, transverse , billowing
Tissue repair
- Good quality and adequate tissue.
Coaptation surface
Remodelling of annulus

20. Decision Making
We should try our best to repair rheumatic MV especially in :
Young patients
Need for pregnancy
Poor compliance for medication
Inappropriate health care system
For those elderly with complex pathology, high co-morbidity, MVR with bioprosthesis should be proceeded.

21. Conclusion Rheumatic inflammation affects every part of MV complex.
Fibrotic with calcified mitral valve is a complex pathology that impairs mitral dynamics BOTH diastole and systole.
Rheumatic MS is often associated with severe tissue retraction and subvalvular problem that needs both tissue and chordal repair.
Autologous pericardium and PTFE chordal replacement are useful and reliable tools.