Hide Your Chordae In The Ventricle: A Novel Technique For Endoscopic Mitral Valve Surgery Using Artificial Chordae
Rafik Margaryan, Giacomo Bianchi, Marco Solinas.
Ospedale Del Cuore Fondazione 'G. Monasterio', Massa, Italy.
Background: Mitral valve repair with artificial chordae for degenerative mitral regurgitation is widely adopted. We aim to share our results of mitral repair with expanded polytetrafluoroethylene sutures (GORE-TEX CV-5; W. L. Gore & Associates, Inc, USA) in fully endoscopic settings using novel technique of putting (hiding) neochordae in the wentricle while perfoming other procedures and pulling them out at the end of prosedure for chordae lenght aditiona adjustment and final valve test.Methods:
Between Jul 2015 and Dec 2017, 145 consecutive patients underwent mitral repair with artificial neochordae in fully endoscopic setup. Mean age was 60.3 <span class="MathJax" id="MathJax-Element-1-Frame" tabindex="0" data-mathml="±" role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative;">± 12.9; 69 % were male. Neochorde as a part of valve repaire was implanted in 70 % cases Valve disease was purely degenerative in 132 patients (91%).
In 43% cases the neocordae were hide in the ventricle while proceeding with annular stitch implantation. Results: In-hospital mortality was 0 % (no deaths).The mean intervention duration, cardio-pulmonary bypass time and aortic cross clamping time were not different in two groups (respectivelly, p = 0.84 p = 0.51 p = 0.22 ). When counting the complexity of the intervention, there were still time gain in all groups and subgroups (See Figure 1). There were non intraoperative complication associated with this simple technique. No calcification or rupture of neochordae neochordae was reported.
Conclusion: Mitral valve repair with neochordae in fully endoscopic setup is effective adding this simple technique. It proved to be safe, and associated with no intraoperative complications.
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