Mitral valve translocation (MVT) is a novel procedure that was developed to treat patients with severe, symptomatic, secondary mitral regurgitation (MR). MVT enhances leaflet coaptation by insertion of an autologous pericardial patch interposed between the mitral annulus and the native mitral leaflets. The patch substantially increases total leaflet surface area and creates supranormal coaptation. In addition, it relieves leaflet tethering by transposing the native valve deeper into the ventricle and decreases the circumference of the annulus. The enhanced coaptation produced by MVT may protect against recurrent MR in patients with continued adverse left ventricular remodeling. The procedural steps include detachment of the intact native mitral valve at the annulus, placement of interrupted pledgeted sutures around the annulus to secure the proximal aspect of the patch, and attachment of the native valve to the distal aspect of the patch using running suture. Follow-up of patients who have undergoing MVT is ongoing, with satisfactory short-term results, including sustained MR grades of ≤mild and 14 mm coaptation at 12 months.
LevineRAHagégeAAJudgeDP, et al. Mitral valve disease—morphology and mechanisms. Nat Rev Cardiol2015; 12: 689–710.
3.
GolbaKMokrzyckiKDrozdzJ, et al. Mechanisms of functional mitral regurgitation in ischemic cardiomyopathy determined by transesophageal echocardiography (from the Surgical Treatment for Ischemic Heart Failure Trial). Am J Cardiol2013; 112: 1812–1818.
4.
BotheWTimekTATibayanFA, et al. Characterization of 3-dimensional papillary muscle displacement in in vivo ovine models of ischemic/functional mitral regurgitation. J Thorac Cardiovasc Surg2019; 157: 1444–1449.
5.
ReeceTBTribbleCGEllmanPI, et al. Mitral repair is superior to replacement when associated with coronary artery disease. Ann Surg2004; 239: 671–677.
6.
BraunJvan de VeireNRKlautzRJM, et al. Restrictive mitral annuloplasty cures ischemic mitral regurgitation and heart failure. Ann Thorac Surg2008; 85: 430–437.
7.
GoldsteinDMoskowitzAJGelijnsAC, et al. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med2016; 374: 344–353.
8.
MagneJSénéchalMMathieuP, et al. Restrictive annuloplasty for ischemic mitral regurgitation may induce functional mitral stenosis. J Am Coll Cardiol2008; 51: 1692–1701.
9.
GreenRDagumPGlassonJ, et al. Restricted posterior leaflet motion after mitral ring annuloplasty. Ann Thorac Surg1999; 68: 2100–2106.
10.
HungJPapakostasLTahtaSA, et al. Mechanism of recurrent ischemic mitral regurgitation after annuloplasty: continued LV remodeling as a moving target. Circulation2004; 110(11 suppl1): II85–II90.
11.
MagneJPibarotPDagenaisF, et al. Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation. Circulation2007; 115: 782–791.
12.
NappiFNennaAMihosC, et al. Ischemic functional mitral regurgitation: from pathophysiological concepts to current treatment options. A systemic review for optimal strategy. Gen Thorac Cardiovasc Surg2021; 69: 213–229.
13.
MessasEGuerreroJLHandschumacherMD, et al. Chordal cutting: a new therapeutic approach for ischemic mitral regurgitation. Circulation2001; 104: 1958–1963.
14.
RomanoMAPatelHJPaganiFD, et al. Anterior leaflet repair with patch augmentation for mitral regurgitation. Ann Thorac Surg2005; 79: 1500–1504.
15.
LangerFRodriguezFChengA, et al. Posterior mitral leaflet extension: an adjunctive repair option for ischemic mitral regurgitation?J Thorac Cardiovasc Surg2006; 131: 868–877.
16.
IkedaNYamaguchiHTakagakiM, et al. Extended posterior leaflet augmentation for ischemic mitral regurgitation: augmented posterior leaflet snuggling up to anterior leaflet. Circ J2019; 83: 567–575.
17.
AschFMGrayburnPASiegelRJ, et al. Echocardiographic outcomes after transcatheter leaflet approximation in patients with secondary mitral regurgitation: the COAPT Trial. J Am Coll Cardiol2019; 74: 2969–2979.
18.
MaisanoFFranzenOBaldusS, et al. Percutaneous mitral valve interventions in the real world. J Am Coll Cardiol2013; 62: 1052–1061.
19.
AilawadiGLimDSMackMJ, et al. One-year outcomes after MitraClip for functional mitral regurgitation. Circulation2019; 139: 37–47.
20.
NeussMSchauTIsotaniA, et al. Elevated mitral valve pressure gradient after MitraClip implantation deteriorates long-term outcome in patients with severe mitral regurgitation and severe heart failure. JACC Cardiovasc Interv2017; 10: 931–939.
21.
GammieJSQuinnRWStraussER, et al. Initial clinical experience with mitral valve translocation for secondary mitral regurgitation. Ann Thorac Surg2021; 112: 1946–1953.
22.
PasrijaCTranDGhoreishiM, et al. Degenerative mitral valve repair simplified: an evolution to universal artificial cordal repair. Ann Thorac Surg2020; 110: 464–473.
23.
MalhotraAMajmudarSSiddiquiS, et al. Midterm results of mitral valve repair with pericardial leaflet augmentation: a single-center experience. Semin Thorac Cardiovasc Surg2020; 32: 433–440.
24.
QuinnRWPasrijaCBernsteinDA, et al. Mitral valve translocation: optimization of patch geometry in an ex vivo model of secondary mitral regurgitation. J Cardiovasc Transl Res2021; 15: 666–675.
25.
StraussERQuinnRWPasrijaC, et al. Intraoperative echocardiographic assessment of mitral valve translocation. Eur J Cardiothorac Surg2022; 62: ezac133.
26.
LazamSVanoverscheldeJLTribouilloyC, et al. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: analysis of a large, prospective, multicenter, international registry. Circulation2017; 135: 410–422.
27.
GillinovAMWierupPNBlackstoneEH, et al. Is repair preferable to replacement for ischemic mitral regurgitation?J Thorac Cardiovasc Surg2001; 122: 1125–1141.
