A journey from resect to respect to restore: aiming at optimal physiological surgical mitral valve repair

Abstract

The concept of 'repairing' a degenerated mitral valve in order to restore the native competence means achieving the best physiological result coupled with the least invasive approach: this represents an interesting challenge for cardiac surgeons. The evolution of cardiac surgery through the years has involved techniques and technologies in every field of interest. From 'resect', to 'respect', to 'restore': the micro-invasive approach based on Neochord implant implies a transapical beating heart surgery which is based on the concept of implanting artificial chordae, preserving the physiological dynamics of the mitral annulus and avoiding the disadvantages of cardiopulmonary bypass and cardioplegic arrest of the heart.

Microinvasive mitral valve repair with transapical mitral neochordae implantation

“…Each type of defect has different causes and can involve different components of the MV apparatus (i.e., type II could be determined by an elongation or rupture of chordae or papillary muscle) and has well-defined surgical possibilities in order to be repaired (4). According to these basic but paramount concepts, the repair of mitral valve regurgitation using transapical microinvasive neochordae implantation is indicated in patients with severe chronic degenerative mitral valve regurgitation and Carpentier's type II lesion, in particular chordal elongation and/or rupture causing leaflet prolapse/flail, in order to restore the competence of the valve (5). Together with severe MVR and leaflet prolapse/flail, correct patient selection requires a careful assessment of other aspects such as annular diameter and left ventricular volume.…”