How to Adjust Neochordae Length Accurately in Degenerative Mitral Regurgitation

Rodríguez-Roda, Jorge; Hycka, Javier Miguelena; López, José Antonio García; Martín, Miren; Muñoz, Rafael

doi:10.1016/j.athoracsur.2017.11.033

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…A simple method described by Kasegawa is based on readjusting chordal length by placing tourniquets and optimizing the length after competence testing 33 . Alternatively, the plane of the annuloplasty ring's suture proved to be an effective point to adjust the optimal length, even just considering the anterior annulus and a dedicated prosthetic ring has been developed accordingly 34–36 …”

Section: Surgery For Degenerative Mitral Regurgitationmentioning

confidence: 99%

“…33 Alternatively, the plane of the annuloplasty ring's suture proved to be an effective point to adjust the optimal length, even just considering the anterior annulus and a dedicated prosthetic ring has been developed accordingly. [34][35][36] Last but not least, a fundamental technique based on the nonresectional statement is the 'double orifice' originally described by Pomerantzeff and later identified as 'edge-toedge' which aims to reduce the valve incompetence suturing in the A2-P2 zone in order to create a double-orifice area. 37 This technique 'respects' native structures, although it does not reproduce a physiological competence (Fig.…”

Section: 'Respect'mentioning

confidence: 99%

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

Mastro

Angelini

D’Onofrio

et al. 2022

Journal of Cardiovascular Medicine

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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.

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Section: Surgery For Degenerative Mitral Regurgitationmentioning

confidence: 99%

Section: 'Respect'mentioning

confidence: 99%

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

Mastro

Angelini

D’Onofrio

et al. 2022

Journal of Cardiovascular Medicine

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“…Despite its success, proper sizing of neochordae remains a challenge as the procedure is performed on a flaccid heart, but its accuracy cannot be assessed until the heart is beating, and the slippery nature of ePTFE that complicates knot typing. Different techniques, tools [14][15][16][17][18][19][20][21][22][23] and algorithms 24 to determine optimal size were reported, and configurations such as pre-measured chordae are now in use 25,26 . Borger et al summarized the limitations and challenges with all of these techniques, concluding that anatomical dimensions in a fully loaded state may be the best guides 27 .…”

Section: Introductionmentioning

confidence: 99%

Performance and healing of an expanded polytetrafluoroethylene multichordal device at 6 months after repair of mitral leaflet flail in swine

Chawla

Frater

Cunningham

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Repairing a prolapsing mitral valve that involves multiple cusps, is procedurally complicated and carries a higher risk of failure when performed with individual neochordae. Inserting multiple neochordae into the papillary muscle, sizing and aligning them in a manner that can restore coaptation is challenging. A multi-chordal mitral valve apparatus (MitraPatch) with a single neo-papillary muscle section, four neochordae with each chord ending in a neoleaflet section was developed. In this study, the 6-month outcomes of using this apparatus to repair mitral prolapse in swine is reported. Methods: Seven pigs (n=7) with prolapse from mitral chordal transection were repaired with the device. 1 pig was acutely terminated to develop the procedure, and 6 swine were survived to 150 days (n=4) and 180 days (n=2), with monthly echocardiographic examinations. At termination, all hearts were explanted for gross necropsy and detailed histopathology. Results: Severe mitral regurgitation was created after chordal transection in all the pigs. Repairing the valve with the device reduced MR to none-or-trace levels in 3 swine, grade 1 MR in 3 swine and 1-2+ in 1 swine immediately after surgery. In the pigs with none/trace/grade 1 MR, the device was intact and coaptation was fully restored as observed on serial echocardiograms. The device was intact, without dehiscence, stretching or fibrosis at termination. The neo-leaflet and neo-papillary sections of the device elicited a host response, which we know is on track to product

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“…30 The artificial neochord implantation repair technique, though it is reversible, has its own challenges in length estimation, configuration optimization, and the limited ability to address redundant tissue. [31][32][33][34][35][36] A few studies also reported a large range of artificial neochord numbers, 37,38 yet limited evidence exists regarding the optimal number of artificial neochordae to be implanted for primary MR. Overall, the presence of a large variety of MV repair techniques, which vary greatly in exact deployment details, suggests an important knowledge gap in our understanding of how 1 particular repair technique is better than others.…”

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confidence: 99%

Large Animal Translational Validation of 3 Mitral Valve Repair Operations for Mitral Regurgitation Using a Mitral Valve Prolapse Model: A Comprehensive In Vivo Biomechanical Engineering Analysis

Zhu,

Yajima,

Park

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: Various mitral repair techniques have been described. Though these repair techniques can be highly effective when performed correctly in suitable patients, limited quantitative biomechanical data are available. Validation and thorough biomechanical evaluation of these repair techniques from translational large animal in vivo studies in a standardized, translatable fashion are lacking. We sought to evaluate and validate biomechanical differences among different mitral repair techniques and further optimize repair operations using a large animal mitral valve prolapse model. METHODS: Male Dorset sheep (n=20) had P2 chordae severed to create the mitral valve prolapse model. Fiber Bragg grating force sensors were implanted to measure chordal forces. Ten sheep underwent 3 randomized, paired mitral valve repair operations: neochord repair, nonresectional leaflet remodeling, and triangular resection. The other 10 sheep underwent neochord repair with 2, 4, and 6 neochordae. Data were collected at baseline, mitral valve prolapse, and after each repair. RESULTS: All mitral repair techniques successfully eliminated regurgitation. Compared with mitral valve prolapse (0.54±0.18 N), repair using neochord (0.37±0.20 N; P =0.02) and remodeling techniques (0.30±0.15 N; P =0.001) reduced secondary chordae peak force. Neochord repair further decreased primary chordae peak force (0.21±0.14 N) to baseline levels (0.20±0.17 N; P =0.83), and was associated with lower primary chordae peak force compared with the remodeling (0.34±0.18 N; P =0.02) and triangular resectional techniques (0.36±0.27 N; P =0.03). Specifically, repair using 2 neochordae resulted in higher peak primary chordal forces (0.28±0.21 N) compared with those using 4 (0.22±0.16 N; P =0.02) or 6 neochordae (0.19±0.16 N; P =0.002). No difference in peak primary chordal forces was observed between 4 and 6 neochordae ( P =0.05). Peak forces on the neochordae were the lowest using 6 neochordae (0.09±0.11 N) compared with those of 4 neochordae (0.15±0.14 N; P =0.01) and 2 neochordae (0.29±0.18 N; P =0.001). CONCLUSIONS: Significant biomechanical differences were observed underlying different mitral repair techniques in a translational large animal model. Neochord repair was associated with the lowest primary chordae peak force compared to the remodeling and triangular resectional techniques. Additionally, neochord repair using at least 4 neochordae was associated with lower chordal forces on the primary chordae and the neochordae. This study provided key insights about mitral valve repair optimization and may further improve repair durability.

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How to Adjust Neochordae Length Accurately in Degenerative Mitral Regurgitation

Cited by 8 publications

References 6 publications

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

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

Performance and healing of an expanded polytetrafluoroethylene multichordal device at 6 months after repair of mitral leaflet flail in swine

Large Animal Translational Validation of 3 Mitral Valve Repair Operations for Mitral Regurgitation Using a Mitral Valve Prolapse Model: A Comprehensive In Vivo Biomechanical Engineering Analysis

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