Minimally invasive left thoracotomy and prosthetic valve mini skirt for recurrent mitral paravalvular regurgitation

Paravalvular leaks still occur following prosthetic valvular replacement. When the paravalvular leaks are significant and causing symptoms or hemolysis, they require closure. Numerous operative techniques, including transcatheter interventions, hybrid approach are described in the literature to treat paravalvular leaks. We describe a minimally invasive left thoracotomy surgical technique that can secure closure of recurrent mitral paravalvular leak in a patient undergoing open-heart surgery for the fifth time. This surgical technique involves the minimally invasive left thoracotomy, sewing a piece of prosthetic material (bovine pericardium or synthetic material) to create a mini skirt around the commercially available valve by using prolene and placing the valve in the annulus in standard manner. After seating the valve in to the annulus, the prosthetic material is sutured all around in the atrial wall without occluding the pulmonary vein orifices. This strategy seems to offer a good solution to the clinical problem of some paravalvular leaks that lie within the vicinity of all vital structures. In this way there is no need to pull rigid annulus or incorporate adjacent vital tissue around the mitral annulus. We believe, this surgical technique is beneficial and represents an additional useful strategy for the surgeon's armamentarium.