Neochordal repair of the posterior mitral leaflet

Nigro, John J.; Schwartz, Daniel S.; Bart, Robert D.; Bart, Candace W; Lopez, Becky; Cunningham, Mark J.; Barr, Mark L.; Bremner, Ross M.; Haddy, Steven; Wells, Winfield J.; Starnes, Vaughn A.

doi:10.1016/j.jtcvs.2003.09.035

Cited by 30 publications

(21 citation statements)

References 22 publications

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“…The period free from reoperation reaches 95–98% in a 10-year follow-up [4]. In our patients neochordal repair, without partial leaflets resection, gave satisfactory results, as confirmed by previous authors [5]. …”

Section: Discussionsupporting

confidence: 88%

Computed tomography angiography for imaging results of neochordal mitral valve repair

Zwoliński

Marcinkiewicz

Szymczyk

et al. 2017

kitp

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IntroductionDegenerative mitral regurgitation is currently the most frequent indication for mitral valve repair.AimTo visualize and assess the mid-term results of mitral valve repair with neochordae implantation, using computed tomography angiography (CTA) imaging.Material and methodsThe CTA with ECG gating and without modulation was applied in 10 patients to assess the results of a mitral valve sparing procedure. The results of 3 patients are presented. The patients were operated on for severe symptomatic degenerative mitral regurgitation, defined according to a modified Carpentier’s functional classification.ResultsNeochordal repair, by placing expanded polytetrafluoroethylene sutures between the leading edge of the prolapsing segment and the corresponding papillary muscle, was conducted. From 1 to 3 double Gore-Tex loops were used. Leaflet clefts, if present, were sutured. All repairs included mitral valve ring annuloplasty. The CTA was performed at 20–24 months after the surgery. Long-axis views, reconstructed during mid-systole, seemed to be the most valuable. Good quality cardiac images, precisely presenting the mitral valve complex with its constituents, were obtained in the case of patients without obesity, with a relatively small anterior-posterior thorax dimension, with sinus, slow heart rhythm and quite good left ventricle contractility. The evaluation of the mitral valve included presence of calcifications, fibrosis or thickening, chordal insertion and coaptation points, and papillary muscle locations. Primary and secondary native chordae tendineae and artificial chordae were visualized.ConclusionsContrast material-enhanced ECG-gated CTA applied after mitral valve repair with Gore-Tex neochordae allows one to obtain satisfactory mitral valve images, especially during mid-systole, and evaluate mid-term results of the surgery in chosen patients.

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Section: Discussionsupporting

confidence: 88%

Computed tomography angiography for imaging results of neochordal mitral valve repair

Zwoliński

Marcinkiewicz

Szymczyk

et al. 2017

kitp

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“…Techniques that did not imply resection of any part of the posterior leaflet were described by different authors 10–15 . In 2006, we published our results: In that series 29 patients had nonresecting techniques when P2 insertion was longer than 1/3 of the posterior annulus, which included use of artificial chords, and in 11 cases, longitudinal plication of the posterior leaflet to reduce its height 16 .…”

Section: Discussionmentioning

confidence: 94%

Resecting and Nonresecting Techniques for Posterior Mitral Leaflet Prolapse

Calafiore

Mauro

Iacò

et al. 2010

Journal of Cardiac Surgery

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“…Although the resectional techniques demonstrate excellent results with low mortality, the durability of valve repair does decline over time . Neochord repair restores normal leaflet coaptation without creating excessive leaflet stress and provides excellent durability; some suggest that durability with chordal replacement techniques may exceed that achieved with leaflet resection . To date, however, data suggest equivalence between resection and chordal replacement in the management of posterior leaflet prolapse …”

Section: Resultsmentioning

confidence: 99%

Choosing the “Best” surgical techniques for mitral valve repair: Lessons from the literature

et al. 2019

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Mitral valve (MV) repair is the procedure of choice to correct mitral regurgitation caused by degenerative MV disease, due to its well‐documented superiority over MV replacement. Repair of the MV is feasible in more than 95% of such patients and restores valve function and preserve ventricular function. Surgeons choose from a wide variety of mitral repair techniques, with the ultimate procedure based upon the pathology and the particular surgeon's personal preference. As a result, there is considerable controversy concerning choice of repair techniques and prostheses (ie, annuloplasty device). This targeted review of available data concerning repair of the degenerative valve will inform surgeon decision‐making in MV repair.

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Neochordal repair of the posterior mitral leaflet

Abstract: Myxomatous mitral regurgitation due to posterior leaflet insufficiency can be repaired without leaflet resection by placement of neochordae. This repair technique is effective and is readily accomplished by traditional and minimally invasive surgical approaches.

Cited by 30 publications

References 22 publications

Computed tomography angiography for imaging results of neochordal mitral valve repair

Computed tomography angiography for imaging results of neochordal mitral valve repair

Resecting and Nonresecting Techniques for Posterior Mitral Leaflet Prolapse

Choosing the “Best” surgical techniques for mitral valve repair: Lessons from the literature

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