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A Mitral Valve Replacement for Rheumatic Heart Disease Through an Upper Hemisternotomy
Gaudiani V, Tsai P. A Mitral Valve Replacement for Rheumatic Heart Disease Through an Upper Hemisternotomy. January 2025. doi:10.25373/ctsnet.28147346
The patient was a 68-year-old man who initially presented with symptoms of asthma, but it was later determined to be shortness of breath due to rheumatic mitral valve disease.
Dr. Vince Gaudiani used an upper hemisternotomy, femoral vein cannulation, and an incision through the roof of the left atrium. Dr. Gaudiani believes this approach provides much better visualization than the Sondegaard’s groove approach.
He prefers to place some of the annulus sutures before removing the calcified valve, using the calcified valve as a handle to facilitate suture placement.
Dr. Gaudiani also discussed placing sutures through the aorta into the left atrium, aided by the rooftop incision.
He then removed the leaflets and discussed the merits of removing the chords of the leaflets prior to removing all the chords. The mitral valve was then replaced with an Epic Plus biological valve, whose struts protrude less into the ventricle. Finally, the left atrial appendage was stapled.
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