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Ischemic Mitral Valve Repair using On Pump Beating Heart Technique
Jorge I. Balzan, Jose Navia, Nicolas Brozzi, Sinal Patel, Rene Aleman, Otto Montero.
Cleveland Clinic, Weston, FL, USA.

OBJECTIVE:The purpose of this video is to demonstrate an ischemic mitral regurgitation valve repair using an OnPump Beating Heart technique
METHODS:A median sternotomy was performed:The ascending aorta, the superior (SVC) and inferior vena cava (IVC) were cannulated. After performing a Coronary Bypass Surgery times 3 with an OnPump Beating Heart technique, we focus attention on the mitral valve the SVC and IVC are snared. The right atrial is open and the atrial septum is transected transversally and extended through the dome of the left atrium. Two cardiotomy suctions are kept one inside the coronary sinus, and the second one in the left atrium. The aortic valve competence is essential to keep the blood less and avoid air embolism, the LV cavity is filled with saline solution and the mitral valve is sized.Then the annuplasty stitches are passed through the mitral annuloplasty ring, the ring is seated, the ring handle is removed, and the sutures are tied first at the level of the anterior annulus and both trigones to properly seat the ring, and then the posterior portion of the annuloplasty ring. Saline solution irrigation test is injected into the LV and demonstrated a competent mitral valve repair
RESULTS:Postoperative echocardiogram showed well seated mitral annuloplasty ring, and normal mitral valve function with trivial MV regurgitation.
CONCLUSIONS:On Pump Beating heart technique is a safe, effective, and valuable option, and should be considered for a severe ischemic MR with a poor LV function.


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