Simplifying Mitral Valve Repair: A Guide to Neochordae Reconstruction

Abstract

Mitral valve reconstruction techniques using polytetrafluoroethylene sutures are associated with high repair rates and excellent durability but are dependent on accurate neochordae length estimates. Current strategies to determine the appropriate length of artificial neochordae commonly rely on nonphysiologic saline testing on the arrested heart, with erroneous lengths resulting in residual mitral regurgitation. We present a guide for reproducible and accurate neochordae reconstruction based upon transesophageal echocardiographic measurements, which simplifies mitral repair for most patients with degenerative mitral regurgitation and can be used in conventional or minimally invasive approaches.

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

“…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.…”