Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops

University of Cape Town, Kaapstad, Western Cape, South Africa
The Annals of Thoracic Surgery (Impact Factor: 3.85). 01/2001; 70(6):2166-8. DOI: 10.1016/S0003-4975(00)02047-6
Source: PubMed


Part of the complexity of mitral valve chordal replacement with expanded polytetrafluoroethylene (ePTFE) sutures is determining the correct replacement chordal length and knotting the ePTFE suture without sliding the knot. We describe a technique of measuring the required chordal length and making a "premeasured" Gore-Tex chordal loop that abolishes problems of inadvertently altering chordal length during fixation. This improves the reproducibility of chordal replacement surgery, and can be used both via conventional and minimally invasive approaches.

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    • "which makes it difficult to predict the effects of surgery, especially if complex procedures like a leaflet tissue resection or the implantation of artificial chordae tendinae are performed [29] [33]. According to Carpentier et al. [6], failure to tailor the repair surgery to the individual patient geometry leads to poor results. "
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    ABSTRACT: Mitral valve (MV) diseases are among the most common types of heart diseases, while heart diseases are the most common cause of death worldwide. MV repair surgery is connected to higher survival rates and fewer complications than the total replacement of the MV, but MV repair requires extensive patient-specific therapy planning. The simulation of MV repair with a patient-specific model could help to optimize surgery results and make MV repair available to more patients. However, current patient-specific simulations are difficult to transfer to clinical application because of time-constraints or prohibitive requirements on the resolution of the image data. As one possible solution to the problem of patient-specific MV modeling, we present a mass-spring MV model based on 3D transesophageal echocardiographic (TEE) images already routinely acquired for MV repair therapy planning. Our novel approach to the rest-length estimation of springs allows us to model the global support of the MV leaflets through the chordae tendinae without the need for high-resolution image data. The model is used to simulate MV annuloplasty for five patients undergoing MV repair, and the simulated results are compared to post-surgical TEE images. The comparison shows that our model is able to provide a qualitative estimate of annuloplasty surgery. In addition, the data suggests that the model might also be applied to simulating the implantation of artificial chordae. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Computerized medical imaging and graphics: the official journal of the Computerized Medical Imaging Society 07/2015; 45:26-35. DOI:10.1016/j.compmedimag.2015.07.009 · 1.22 Impact Factor
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    • "Artificial chordal reconstruction is thus becoming a more popular technique for mitral valve repair; however, artificial chordal reconstruction for extended mitral prolapse requires many ePTFE chordae, and adjustment of the chordal lengths can be technically cumbersome. Opell and Mohr [9] developed a new artificial chordal reconstruction technique involving the use of numerous ePTFE loops. The loop technique is suitable for both minimally invasive and conventional sternotomy approaches. "
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    ABSTRACT: Artificial chordal reconstruction technique uses several expanded polytetrafluoroethylene loops to achieve mitral valve repair. We studied retrospectively 180 patients who underwent mitral valve repair using the loop technique via median sternotomy: 86 for posterior leaflet prolapse, 48 for anterior leaflet prolapse and 26 for bileaflet prolapse. Of the 180 patients, 138 required 1 loop set; 40 patients required 2 and 2 patients with Barlow's disease required 3. Loop sets contained two to nine loops ranging in length from 14 to 26 mm. Additional techniques required to ensure complete repair using the loop technique included commissural edge-to-edge suture in 78 patients, loop-in-loop technique for extension of the artificial loop in 18 and use of needle-side sutures in 18. Systolic anterior leaflet motion was observed in only 2 patients (1.1%). One patient with immune deficiency died of sepsis. Predischarge echocardiograms showed no or trace mitral regurgitation (MR) in 160 patients (89%), mild MR in 17 patients (9.4)% and mild-to-moderate MR in 3 patients (1.7%). Only 1 patient required redo operation due to recurrent MR freedom from MR greater than moderate was seen in 98.0 ± 1.4% of patients at 1 year, 91.5 ± 2.8% of patients at 3 years, and 91.5 ± 2.8% at 5 years postoperatively. No significant difference was seen in the rate of recurrence of MR among the sites of prolapsing leaflets. The loop technique via median sternotomy to treat posterior, anterior and, especially, bileaflet prolapse provided satisfactory mid-term outcomes.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 04/2014; 47(3). DOI:10.1093/ejcts/ezu175 · 3.30 Impact Factor
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    • "This difficulty was even more pronounced when surgeons tried to apply this technique via a minimally invasive approach. In 2000, Mohr et al. introduced the “loop technique” to address these limitations, which consisted of a pre-manufactured pledget with 4 single 5-0 Gore-Tex loops [23]. The pledget was sutured to the papillary muscle and the ends of the loops were then fixed to the leaflet segments. "
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    ABSTRACT: Minimally invasive mitral valve repair is based on several procedural concepts. Recently, three of them have been intensively discussed: aortic occlusion strategy, use of Goretex-Neo-Chordae to repair mitral valve regurgitation and feasibility and efficacy of the minithoracotomy approach in mitral valve treatment of patients after previous cardiac surgery. Twenty years of experience in minimally invasive mitral valve repair have enabled high-volume centers to present valid data and give their recommendations. Transthoracic aortic clamping with ante- and retrograde cardioplegia in the primary setting and hypothermic fibrillation in reoperative setting are currently favoured means of myocardial protection. Neo-chordae concept of mitral valve repair has gained general recognition and has become the technique of choice for many surgeons. The excellent results of minimally invasive mitral valve repair must be considered whenever already available or any new transcatheter techniques are offered.
    03/2013; 5(4):207-212.
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