Simple Technique Of Artificial Chordae Implantation In Robotic Cardiac Surgery Using Cordarizer Tz
Takeo Tedoriya, MD, PhD.
Ageo Central General Hospital, Ageo, Saitama, Japan.
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Simple technique of artificial chordae implantation in robotic cardiac surgery using Cordarizer TZ
Takeo Tedoriya, Ryoi Okano, Tadamasa Miyauchi, Yuko Gatate, Masaomi Fukuzumi
Ageo Central General Hospital, Cardiovascular Center
Objectives: Artificial chordae implantation has been used for mitral valve repair, as important technique not only for anterior leaflet lesion but also posterior prolapse. In addition to decision of length of artificial chordae, ligation without loosing is critical problem, but appropriate ligation without laxity nor shortening of the sutures also critical issue, especially in minimally invasive procedure including robotics surgery. We applied Cordarizer for artificial chordae implantation in robotics mitral valve surgery in order to secure ligation of CV4 as an artificial chordae using robotics arms.
Methods (surgical technique): Our setting for Da Vinci mitral valve surgery; the working port was placed on the right anterior axillary line in 4th ICS with length of 3cm, a camera port and the left atrial retractor port in the 4th ICS, the left-arm port in the 2nd or 3rd ICS, and the right-arm port in the 6th ICS. After establishment of the peripheral cannulation, da Vinci system was rolled in for docking.
Mitral valve was investigated via the right side of the left atrium. When the lesion of leaflets were confirmed by water-test, CV4 was stitched to the target papillary muscle. The length of neo-chordae was measured by a special measurement device, then CV4 was passed through appropriate Chordarizer. CV4 was stitched to the target point of leaflet margin from the left ventricle side, thereafter tied each other by da Vinci arms. Finally, Chordarizer was peeled away.
Results: The series of procedures were simple and easy, without any technical complications. Neo-chordae using Chordarizer were placed and functioning as planned.
Conclusion: Chordarizer provided safe and assured procedures of neo-chordae implantation, maintaining the measured length in ligation of CV4 on the surface of the mitral valve leaflets with da Vinci system.
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