New Adjustable Artificial Chord For Mitral Repair Innovative Method To Ensure Accurate Length
Faouzi Safadi1, Alaaddin Yilmaz2, Mattia Glauber3.
1Dubai Hospital - Dubai Health Authority, DUBAI, United Arab Emirates, 2Jessa Hospital, Hasselt, Belgium, 3St Ambrogio Clinic Gruppo San Donato, Milan, Italy
Objective: In recent years, neo-chordae have become an established adjunct in Mitral valve repair. Despite all technical improvements, achieving ideal neo-chordae length remains a challenge. We propose a novel, method of neo-chordal sizing based on an adjustable PTFE/simple-loop, formed with specific "sliding-stitch". The "sliding-stitch" mechanism is similar-to that of a necktie-knot, allowing an unlimited fine-tuning of the loop size, eventually ensuring the appropriate neo-chordal length.
Methods: This neo-chord consists in: 1-threaded in a single-passage mode, and therefore freely sliding, through both the leaflet and papillary muscle; 2-incorporating an original sliding-stitch designated to regulate the chordal length. 4-0/PTFE suture is single-threaded through the leaflet, then, through the papillary muscle. A first-arm, emerging from the leaflet, mimics the narrow-end of the tie, A second-arm, emerging from the papillary muscle, mimics the wide-end. The second-arm is crossed anteriorly to the first-arm, a first simple knot is performed, obtaining a preliminary large loop. The second-arm is, then, carried behind the loop on his segment emerging from the papillary muscle, then, a sequential simple knot is performed. The two knots are gently approximated by pulling up both arms: thus, the neo-chord is completed. By pulling up the first-arm, and pushing down the Sliding-Stitch, the size of the loop accordingly decreases gradually dragging the anchored leaflet to the coaptation area. If the Sliding-Stitch is excessively pushed down into the ventricle, the leaflet becomes restricted below the coaptation level. In this case, it is easy to hold the loop above the prolapsed leaflet and carry it down, while simultaneously, the Sliding-Stitch is pulled up. The loop will regain length, allowing the prolapsed free-edge to come back to a higher level at the coaptation area.
Results: This technique has been successfully employed in 83 patients at 3 different institutions and appears especially suitable for minimally-invasive approach.
Conclusions: Neo-chordae represent the essential tool for minimally-invasive Mitral repair. Surgeons are constantly committed to search new solutions for the impervious technical difficulty of neo-chordal sizing. We hope to have found the best way to achieve the accurate length of artificial-chordae. Figure:1 Sequential steps to perform neo-chordae with the sliding stitch.