Mitral Valve Replacement with Total Chordal Preservation: The Eversion Technique

The preservation of the subvalvular apparatus during mitral valve replacement is necessary to maintain the geometry and function of the left ventricle. Although several complete or partial chordal preservation methods have been described, some continue to preserve only the posterior chordal attachments. This is due to a fear of possible patient prosthetic valve mismatch with many well-known chordal preservation techniques. We describe a simple method of preservation of both the leaflets and chordal attachments using a simple eversion technique. In our technique, we retain all the mitral valvular and subvalvular tissue. The excised leaflet ends are everted by the valve sutures to avoid interference with the prosthetic valve leaflets.