Novel approaches to cardiac valve repair: from structure to function: Part I.

In Part I of this article, several aspects of valve structure and function and their possible clinical relevance were discussed. We now review the clinical evolution and application for various forms of valve repair and outline some of the factors relating to the timing and choice of particular types of repair or replacement and, whenever appropriate, repair versus replacement. In addition, future prospects of valve repair based on understanding of the sophisticated function and structure of valves and the possible future contribution of tissue engineering are discussed. The very first attempts at surgical treatment of heart valve disease were directed toward repair of mitral stenosis in the early 1920s by Elliot Carr Cutler1 in Boston and Sir Henry Souttar2 in London. Although some of these operations were successful, it was approximately 30 years before mitral valvotomy was established by Bailey in the United States and Lord Brock and O.S. Tubbs in the United Kingdom. The next heart valve operation to be attempted was repair of mitral regurgitation by Lillehei et al,3 who in 1957 reported “surgical correction of pure mitral regurgitation by annuloplasty under direct vision.” Shortly after that, Dwight McGoon,4 at the Mayo Clinic, introduced “repair of mitral regurgitation for ruptured chordae tendineae by triangular resection of the prolapsing segment,” a major contribution. With the introduction of mechanical valve replacement by Harken, Starr, and others and biological valves (homografts) by Donald Ross and Brian Barratt-Boyes in the early 1960s, there was a swing toward valve replacement. More recently, however, there has been a gradual realization that the ideal operation may be a restorative (repair) operation attempting to reproduce some of the sophisticated functions of a normal valve. This was accompanied by refining and evolving new techniques for repair of different valves by Carpentier5 and …