Echocardiographic Method to Determine the Length of Neochordae Reconstruction for Mitral Repair

Simplifying Mitral Valve Repair: A Guide to Neochordae Reconstruction

“…In our series, 7 98.9% of patients remained free from at least moderate MR at a median follow-up of 12.6 months (interquartile range, 11.1), whereas freedom from reoperation was 100%. Actuarial survival at both 1 and 4 years was 96.9% ± 0.2%.…”

“…We have demonstrated our initial experience with the TEE-guided premeasured loops for posterior, anterior, bileaflet, or commissural prolapse and in single-segment and multisegment disease. 7 From 2008 to 2018, 264 consecutive patients underwent mitral repair with neochordae loop reconstruction with a repair success rate of 100%, and TEE-guided measurements were found to be accurate in 98% of cases. In 4 out of 5 cases showing more than trace residual post-pump MR, conversion to PL resection was performed with good results.…”

“…This calculation typically results in PL neochordae loops measuring 14 to 18 mm. 7 We recognize that the Y segment is an estimation, often measured on the curve of the prolapsing leaflet and prone to interpretation bias. It is frequently estimated around 10 mm, but it can be longer in very redundant PL or shorter if PL is relatively normal (or short) in length, like in fibroelastic disease.…”

“…In general, PL neochordae are expected to be at least 10 mm shorter than AL neochordae in patients with bileaflet prolapse, as the PL is commonly much more redundant (i.e., AL neochordae loops 28 mm, with PL neochordae loops 18 mm). 7 …”

“…However, most rely upon nonphysiologic saline tests on the arrested heart and a degree of “eyeballing.” 6 Hence, to simplify mitral valve repair with artificial chordae, we present a guide for a reproducible and effective neochordae reconstruction technique based upon standardized echocardiographic derived length estimation. 7 …”