Recent developments and evolving techniques of mitral valve reconstruction.

Experiences with 1,000 patients undergoing mitral valve reconstruction at New York University over the past 18 years are summarized. A continuing follow-up (98% complete) demonstrated that 88% of patients are free from recurrent insufficiency 10 years after the operation. Reconstruction is feasible in nearly 90% of patients with mitral valve prolapse, with an operative mortality near 2%. Accordingly, operation is now recommended at an early stage with the first sign of left ventricular systolic dysfunction, while the patient is still in sinus rhythm. Most operations have been done with the Carpentier techniques of segmental resection with annuloplasty and insertion of a Carpentier ring. Recently, two other repair techniques and a minimally invasive operative approach have been evaluated. A triangular resection of a prolapsing anterior leaflet has been done in more than 100 patients with excellent results. Also, a posterior "folding plasty" has been employed in more than 40 patients with a large redundant posterior leaflet, minimizing the need for annular plication. A minimally invasive approach to the mitral valve has now been employed in 130 patients over the past year, using a right mini-thoracotomy and the Port-Access (Heartport, Inc, Menlo Park, CA) approach. This technique employs catheters introduced through femoral vessels to institute cardiopulmonary bypass and cardioplegic arrest. The operative approach and techniques for mitral valve reconstructive operations continue to evolve, with excellent results and improved patient benefits.