Aortic transection with superior biatrial trans-septal approach for triple valve re-do procedures.

The repair of atrioventricular valves requires optimal valve exposure through even unconventional surgical approaches. This is especially true in the situation of multiple re-do valve surgeries, where extensive adhesions may prevent adequate valve exposure. When multiple valve surgeries are contemplated, an extensive incisional approach is required without causing damage to any surrounding crucial structures. Re-do surgeries are described in patients with prosthetic valve endocarditis where the correction of all valves involved is necessary, as is the correction of underlying ventricular pathologies such as sinuses and atrioventricular tunnels. As several surgical approaches have been attempted in these situations, a technique is described which involves a superior biatrial approach after transecting the aorta, which addresses the mitral, tricuspid and aortic valves and allows the correction of associated ventricular pathologies.

A simple technique for securing Gore-Tex neochordal height and knot slippage in mitral valve repair.

Polytetrafluoroethylene or Gore-Tex sutures are used for chordal replacement, and are durable but extremely slippery, a property which causes knot slippage and ineffective neochordal length. We report a modification that is simple and reproducible in preventing knot slippage and maintaining optimal neochordal length, without the use of devices or additional sutures.