Gasparyan Technique of Total Autologous Mitral Valve Substitute for Irreparable Cases

However, in patients with rheumatic valve disease mitral valve repair has an unacceptably high risk of recurrent cases or the valve even becomes fully irreparable. Even in the case of degenerative mitral valve disease, a significant proportion of valves (10%) become irreparable due to severe distortion of the valve. I have invented my method of mitral valve tailoring for its total autologous reconstruction guiding the main principle – the tailored valve has to resemble natural mitral valve anatomy as much as possible, including its primary chordal support. This is a very simple, precise and reproducible method of determination of mitral valve parameters. To make an intra-operative mitral valve tailoring simple, fast and reproducible I offered the templates of different sizes based on the inter-commissural distance of the valve and the formulas described in my method. The first successful clinical case report is described in this chapter. My method of total autologous reconstruction of the mitral valve was used to operate a 56-year-old man with severe rheumatic mitral stenosis (valve area = 0,9 cm2, max PG on the valve = 31 mm Hg) with heavily calcified posterior leaflet and aortic insufficiency III degree, complicated with septic endocarditis and treated with antibiotics for 2 weeks. Preoperative echocardiography showed preserved left ventricular function (EF = 64%, LVEDD = 5,6 cm, LVEDV = 156 ml, LVESV = 56,3 ml). Trans-thoracic echocardiography follow-up 1 month after surgery revealed trivial regurgitation and a peak gradient of 6,6 mm Hg on the newly created pericardial mitral valve. Total autologous mitral valve reconstruction is a safe and effective procedure for severe, irreparable, mitral valve pathologies. However, the mid-term and long-term results need to be compared with conventional mitral valve replacement with a prosthetic valve in a randomized controlled trial.