There have been many different approaches to the mitral valve documented in the cardiac surgical literature. The most commonly employed approaches include the left atrial approach through Sondergaard’s groove and the trans-septal approach. For surgeons seeking to employ complex mitral valve repair techniques, exposure of the entirety of the mitral valve complex is of utmost importance. It is with this import that Dr. Ovidio adds yet another crucial weapon in the practicing surgeon’s armanetarium of exposure of the mitral valve.

In “The Best Exposure of the Mitral Valve: The Pulmonary Veins Isolation Approach”, Dr. Ovidio neatly documents his experience of nearly 200 cases with a novel exposure technique which disconnects the right-sided pulmonary veins from the left atrium and allows the heart to rotate further so as to better expose the mitral valve. While Dr. Ovidio recommends that this may be the optimal exposure for patients with a small left atrium, the mean atrial sizes of the patients in this series were rather large. Too, the mean ejection fraction of patients in this series was over 50% and the cross clamp time was almost two hours. Given the necessary complexity in left atrial reconstruction and the subsequent longer cross clamp times, one wonders if this technique would be optimal for patients with compromised left ventricular function.

Nevertheless, this is an elegant series documenting a novel technique. Mitral valve surgery is all about exposure, exposure, exposure, and Dr. Ovidio gives practicing surgeons yet another excellent tool to better expose the mitral valve.

References

1. Garcia-Villarreal OA (2015) The Best Exposure of the Mitral Valve: The Pulmonary Veins Isolation Approach. J Surg 1. [Ref.]

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Article Information

Article Type: Commentary

Citation: Keeling B (2016) Exposure, Exposure, Exposure. J Surg Open Access 2(3): doi http://dx.doi.org/10.16966/2470-0991.127

Copyright: © 2016 Keeling B. This is an openaccess article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication history: 

Received date: 23 Apr 2016

Accepted date: 25 Apr 2016

Published date: 29 Apr 2016