The Novel Livanova 3d Rechord Semirigid Ring Improves Minimally Invasive Mitral Valve Repair With Arteficial Chords
Gábor Szabó, Ursula Tochtermann, Raffaele De Simone, Matthias Karck.
University of Heidelberg, Heidelberg, Germany.
BACKGROUND: Replacement of diseased chordae with Gore-Tex sutures (neochords) in patients with degenerative mitral valve insufficiency has become a standard technique in mitral valve repair. Nevertheless, determining the correct length of the neochordae has remained problematic. Moreover, the tendency of the knot to slide may result in in difficulty in establishing correct length of the neochords. The novel Livanova 3D ReChord ring with an additional chordal guiding system allows a quick ,,semi-automatic“ sizing and prevents the ,,sliding“ of knots. We compared patients who underwent minimally invasive mitral valve repair with neochords using either the novel Livanova 3D ReChord ring or Carpentier-Edwads (CE) Physio II ring. METHODS: Retrospectively collected data of patients underwent minimally invasive mitral valve repair between January 2015 -December 2017 was undertaken. 20 Patients received mitral valve repair using neochords and Livanova 3D Rechord ring were matched 1:3 with 60 patients with mitral valve repair with neochords and implantation of CE Physio II ring. Pre- intra and early postoperative as well as echocardiographic data were analyzed. RESULTS: All procedures could be performed successfully without residual or with trivial mitral insufficiency. Preoperative characteristics did not differ between the groups. There were eight (13%) in-hospital death in the CE Physio ring group while no death occurred in the Livanova-Group (p<0.05). In the CE Physio Ring group high amount (45%) of additional procedures were necessary (18/60 cleft closure; 9/60 triangular/quadrangular resection) to achieve satisfactory mitral valve competence while none additional corrective measures was required in the Livanova group. Aortic crossclamp (93±9 vs. 122±5min, p<0.00001) and cardiopulmonary bypass time (135±25 vs. 198±31 min p<0.00001) were significantly reduced in the Livanova group. The average number of implanted neochords was also significantly lower in the Livanova group (1.9±0,7 vs. 2.8±1.4 p<0.003). CONCLUSIONS: The use of the Livanova 3D Rechord ring is safe and provides excellent functional results. The chordal guiding system markedly reduces the time of the procedure by facilitating sizing and knotting and reducing the number of necessary neochords, allows an almost complete elimination of concomitant leaflet reconstruction measures and may contribute to reduced mortality after minimally invasive mitral valve repair.
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