Simple and Easy Techniques for Mitral Valve Exposure with a Single Retractor

iDepartment of Cardiovascular Surgery, Narita Red Cross Hospital, Narita 286-8523, Japan and Department of Cardiovascular, Kimitsu Chuo Hospital*, Ki razu, Japanj

Hiroshi Iida Toru Sunazawa Keiichi Ishida
Atsuo Doi Yoshio Sudo* Hideo Ukita*
Adequate exposure is crucial for successful mitral valve surgery. We report simple techniques for optimizing mitral valve exposure via conventional left atriotomy. The right side of the pericardium is sutured to the chest wall after medial sternotomy and pericardiotomy. We mobilize both the superior and inferior vena cava by dissecting the pericardium on their right side. Tourniquets are placed around both venae cavae and hitched up to the left after bicaval cannulation. Then the right side of the left atrium is lifted up and exposed. A longitudinal incision of the left atrium allows excellent exposure of the mitral valve using a single retractor. We adopted these procedures for 38 consecutive patients for mitral valve plasty, and additional incisions were not required. Simple mitral plasty procedure in 18 cases required 212}32 min for operation, 120}22 min for extracorporeal circulation and 88}18 min for aortic cross clamp. We conclude that this method is simple and does not lengthen the procedure.
  Jpn. J. Cardiovasc. Surg. 38:100-102i2009j