Feasibility study of a mechanical suturing device for less invasive mitral operations.

ABSTRACT

BACKGROUND: Because of smaller incisions and limited exposure, less invasive operations on the mitral valve can be arduous and time-consuming. This study examined the feasibility of a mechanical suturing device to facilitate less invasive mitral replacement. METHODS: Five mongrel dogs underwent limited left thoracotomy. After conventional cardiopulmonary bypass and cardioplegia, the mitral valve was exposed through a left atriotomy. After excision of the anterior leaflet, subannular sutures were placed using a mechanical suturing device. This device simultaneously passes two ends of a pledgeted 2-0 braided suture through the valvular annulus, then mechanically grasps both needles on the atrial aspect. Hence, a mattress suture is accomplished one-handed in a single continuous motion. This procedure was repeated around the entire annulus. A mechanical valve was seated and the sutures were tied and cut. RESULTS: All mechanical valves were implanted successfully. In the 4 animals in which it was attempted, cardiopulmonary bypass was successfully weaned. No evidence of perivalvular leak was observed by echocardiography. CONCLUSIONS: These data establish the feasibility of a mechanical suturing device for operations on the mitral valve. The device is easily mastered, maintains precise spacing between sutures, and permits rapid placement of mattress sutures. We predict widespread application for both less invasive and conventional valve operations.