Chordal replacement for both minimally invasive and conventional mitral valve surgery using Premeasured Gore-Tex loops
University of Cape Town, Kaapstad, Western Cape, South AfricaThe Annals of Thoracic Surgery (Impact Factor: 3.85). 01/2001; 70(6):2166-8. DOI: 10.1016/S0003-4975(00)02047-6
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  . According to Carpentier et al. , failure to tailor the repair surgery to the individual patient geometry leads to poor results. "
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.
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- "They were first used in humans in the repair of anterior leaflet prolapse , but have since been used extensively to correct posterior leaflet prolapse    with excellent long-term results . Furthermore, the use of premeasured ePTFE sutures has facilitated the advancement of minimally invasive mitral valve repair  on both leaflets with good long-term results . In a prospective randomized trial, Falk et al. showed that posterior leaflet repair with ePTFE neochordae was comparable with leaflet resection in the early postoperative course, but found that ePTFE repair resulted in a significantly longer line of leaflet coaptation . "
ABSTRACT: Objectives: Resection techniques are the established method for posterior mitral valve leaflet repair in degenerative mitral valve disease. However, implantation of expanded polytetrafluoroethylene (ePTFE) neochordae is gaining acceptance. The aim of this study was to compare the durability and clinical outcome following mitral valve repair using ePTFE neochordae or leaflet resection. Methods: A retrospective study was conducted of 224 patients who had undergone isolated mitral valve repair for degenerative posterior mitral leaflet prolapse from 1998 to 2012 at two cardiothoracic centres, one in Sweden and one in Denmark. Follow-up was performed in February 2013 and was 100% complete for survival (1184 patient-years; mean 5.9 ± 3.9 years). Event rates were estimated with the Kaplan-Meier method. Results: The 30-day mortality rate was 0.5%. Repair was successful in 215 patients (96.0%). Leaflet resection was performed in 146 (72.6%), whereas 55 (27.4%) underwent ePTFE neochordae repair. All patients received an annuloplasty with a mean size of 33 ± 4 mm in the ePTFE group and 31 ± 3 mm in the resection group (P = 0.001). The 5-year survival rate was 98.2 ± 1.8% in the ePTFE group and 93.9 ± 2.1% in the resection group (P = 0.67). At 5 years, the rate of freedom from recurrent moderate or severe mitral regurgitation was 91.9 ± 5.5% in the ePTFE group and 95.8 ± 2.1% in the resection group (P = 0.20), and the rate of freedom from all-cause reoperation was 100% in the ePTFE group and 97.9 ± 1.2% in the resection group (P = 0.36). Conclusions: ePTFE neochordae is noninferior to resection repair for posterior mitral leaflet prolapse. Both techniques have comparable early and mid-term postoperative outcomes with low mortality, and a low incidence of reoperation and recurrent mitral regurgitation.
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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  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. "
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.