‘Loop-in-loop' technique as a key innovation in mitral valve repair through minithoracotomy
Kazuma Okamoto, Mikihiko Kudo, Ryohei Yozu.
Keio University, Tokyo, Japan.
Objective: Although merit of minimally invasive approach for mitral valve surgery is well-known, endoscopic-assisted mitral valve repair via mini-thoracotomy is still not common. Although minithoracotomy approach realizes great surgical exposure of the mitral valve, complicated repair has been thought to be challenging. To facilitate complex repair, multiple neo-chordae reconstructions using 'loop-in-loop' technique was innovated. The efficacy of new innovations in artificial chordal creations in mitral valve repair via minithoracotomy was verified.
Methods: In 288 endoscopic-assisted mitral valve repair via minithoracotomy from 1998 to 2011, multiple neo-chordae creations using ‘loop-technique’ have been a major mitral valve reconstruction technique in 206 cases. Since 2011, "loop-in-loop' technique was introduced as a neo-chordae creation technique and was applied in 29 cases so far and the clinical data with this group was verified retrospectively. A loop set made from a single 5-0 Gore-Tex suture with a Gore-Tex pledget was prepared as a much shorter than predicted distance between the papillary muscle and the tip of the leaflet without pre-measuring. The secondary loop was made between the loop set and the tip of the leaflet with a 5-0 Gore-Tex suture. The length of the secondary loop was determined by comparing with a reference leaflet or saline injection test. Annuloplasty with a ring was done in all cases.
Results: The mean age was 52.4 ± 12.5 years and 27.6% were female. Conversions to sternotomy, operative mortality and major mobility have not occurred. Among them, combination of the ‘loop-in loop' technique and other repair technique were used in 17 cases. The number of the created neo-chordae was 3.6 ± 1.7 in average (1 - 8). In postoperative follow up, rate of freedom from severe mitral regurgitation greater than 2+ was 96.5% in 124.7 ± 74.7 days (5-283).
Conclusions: 'Loop-in-loop' technique is feasible for multiple neo-chordae creations in a complex mitral valve repair via minithoracotomy.
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