Mitral valve replacement with a collar-reinforced prosthetic valve for disrupted mitral annulus.

The mitral valve was replaced with a collar-reinforced prosthetic valve in 6 patients with a disrupted mitral annulus, in 3 because of infective endocarditis, including 2 patients with prosthetic valve endocarditis, in 2 because of a severely calcified mitral annulus, and in 1 who had previously undergone mitral valve replacement twice. Four patients had undergone prior mitral operations; these consisted of mitral valve replacement in 3 patients and mitral valve repair in 1. In all patients, the prosthesis was secured by double-layered sutures, with the first row of buttressed sutures passing through the leaflet or sutured to the left ventricular muscle and through the sewing cuff of the prosthetic valve. The second row of running sutures was then placed through an extended annular equine pericardial cuff of the prosthetic valve and the supraannular left atrial wall. In 2 patients, all chordae tendineae were preserved to maintain annulopapillary muscle continuity. All patients survived and have remained well for a mean of 22.3 months. There has been no prosthetic valve dehiscence, except for minimal paraprosthetic leakage in 1 patient. These results demonstrate that mitral valve replacement in patients with a disrupted mitral annulus can be successfully accomplished with a collar-reinforced prosthetic valve.