Repairing the mitral valve

Repairing the valve allows avoiding support anticoagulation therapy; it reduces the percentage of infections (endocarditis); it allows preserving the tissues of the native valve (including the chordae tendineae) and may be performed, after careful assessment by the Heart Team, at the same time as the remodeling of the left ventricle.

The main operation of mitral valve repair

MitraClip

The MitraClip is a tiny metal clip: applied as a bridge on the cusps of the mitral valve, it helps repair the defective valve which, no longer closing perfectly, allows the blood to flow backward - in part - from the left ventricle to the left atrium (mitral regurgitation).

When the traditional cardiac surgery approach (opening the chest) or the low operative trauma (minimal intercostal incision) approach is advised against - elderly patient, other concomitant diseases, see above - it is possible to “fix” the valve by reaching the heart with a catheter inserted via the femoral vein (percutaneous access).

The positioning of the “clip” - which fully recreates the manual gesture of suturing - is monitored through echocardiographic examination.

The micro-device, released in the area of the valve where the regurgitation originates, is fastened without having to stop cardiac activity and without having to resort to Extracorporeal Circulation (EC, heart-lung machine) with identical results to the classic surgical treatment. In reversing the backward flow of blood it also allows good recovery of the native valve: the damaged leaflets are realigned and fit back together. The improvement in the patient’s state of health is already visible just a few minutes after implantation.

MitraClip

Cardioband

In all conditions of mitral regurgitation due to excessive dilation of the valve ring it is possible today, thanks to the help of the biomedical industry, to eliminate the consequences of the defect (backward flow of blood from left ventricle to left atrium) using the Cardioband system; this is an annuloplasty procedure performed with direct access via the femoral vein. Two intervention phases are envisaged: percutaneous insertion of the device - performed under radiographic and fluoroscopic monitoring - and anchoring of the device to the “incontinent” valve. Anchoring of the Cardioband to the valve tissue is ensured by a series of microstitches applied in succession while the adjustment - variable depending on the interventional requirements - is guaranteed through an instrument capable of remodeling the mitral ring until the functional defect (regurgitation) is eliminated entirely. The Cardioband is implanted with the heart beating: it does not require any type of surgical incision into the chest wall, nor the aid of EC to keep the patient’s extracorporeal circulation active.

Neochord

In the healthy mitral valve, the chordae tendineae - which quite resemble taut parachute strings - keep the cusps (the valve leaflets) stable. In a defective mitral valve it can happen that the diseased chordae tendineae deteriorate - until rupturing - or they stretch too much, preventing them from performing their “job” properly: opening when blood goes from the left atrium to the left ventricle and closing once the blood flow is pushed towards the aorta. Mitral valve repair using the Neochord technique is equivalent to replacement of the damaged filaments with new artificial cords made of Gore-Tex - approx. one millimetre thick and from 5 to 7 cm long - applied under the valve with a suture model similar to the sartorial stitches made by a sewing machine. Once the tendinous component has been restored, the valve reacquires its original integrity (the leaflets no longer prolapse) and it stops “regurgitating blood”. The Neochord technique does not envisage the use of the extracorporeal circulation (EC) machine either as it is implemented with the heart beating: it only requires a small lateral cut in the chest (minithoracotomy) of just 6-8 centimetres.

Neochord