Mitral valve repair using adjustable posterior leaflet neochords

Abstract

Central MessageWe report on a novel technique for implantation of neochordae to the posterior leaflet and demonstrate excellent safety and efficacy in a series of 22 patients.See Commentaries on pages 55, 56, and 58. We report on a novel technique for implantation of neochordae to the posterior leaflet and demonstrate excellent safety and efficacy in a series of 22 patients. See Commentaries on pages 55, 56, and 58. Mitral valve regurgitation (MR) is a common disorder1Freed L.A. Levy D. Levine R.A. Larson M.G. Evans J.C. Fuller D.L. et al.Prevalence and clinical outcome of mitral-valve prolapse.N Engl J Med. 1999; 341: 1-7Crossref PubMed Scopus (698) Google Scholar that has been found to be a powerful predictor of serious morbidity and mortality.2Enriquez-Sarano M. Avierinos J.-F. Messika-Zeitoun D. Detaint D. Capps M. Nkomo V. et al.Quantitative determinants of the outcome of asymptomatic mitral regurgitation.N Engl J Med. 2005; 352: 875-883Crossref PubMed Scopus (577) Google Scholar As such, the management of MR has evolved over time and has trended toward a more aggressive surgical approach to mitral valve pathology.3Suri R.M. Schaff H.V. Enriquez-Sarano M. Mitral valve repair in asymptomatic patients with severe mitral regurgitation: pushing past the tipping point.Semin Thorac Cardiovasc Surg. 2014; 26: 95-101Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar,4Goldstone A.B. Patrick W.L. Cohen J.E. Aribeana C.N. Popat R. Woo Y.J. Early surgical intervention or watchful waiting for the management of asymptomatic mitral regurgitation: a systematic review and meta-analysis.Ann Cardiothorac Surg. 2015; 4: 220-229PubMed Google Scholar This trend is likely a product of the appreciation of the risks associated with untreated MR but also partly attributable to the tremendous progress that has been made with operative mitral valve repair.5Castillo J.G. Anyanwu A.C. Fuster V. Adams D.H. A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines.J Thorac Cardiovasc Surg. 2012; 144: 308-312Abstract Full Text Full Text PDF PubMed Scopus (180) Google Scholar,6Goldstone A.B. Cohen J.E. Howard J.L. Edwards B.B. Acker A.L. Hiesinger W. et al.A “repair-all” strategy for degenerative mitral valve disease safely minimizes unnecessary replacement.Ann Thorac Surg. 2015; 99: 1983-1991Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar Minimally invasive approaches7Cao C. Gupta S. Chandrakumar D. Nienaber T.A. Indraratna P. Ang S.C. et al.A meta-analysis of minimally invasive versus conventional mitral valve repair for patients with degenerative mitral disease.Ann Cardiothorac Surg. 2013; 2: 693-703PubMed Google Scholar and robotic mitral surgery8Gillinov A.M. Mihaljevic T. Javadikasgari H. Suri R.M. Mick S.L. Navia J.L. et al.Early results of robotically assisted mitral valve surgery: analysis of the first 1000 cases.J Thorac Cardiovasc Surg. 2018; 155: 82-91.e2Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar have entered the mainstream and continue to grow in popularity.9Gammie J.S. Zhao Y. Peterson E.D. O'Brien S.M. Rankin J.S. Griffith B.P. Less-invasive mitral valve operations: trends and outcomes from the society of thoracic surgeons adult cardiac surgery database.Ann Thorac Surg. 2010; 90: 1401-1408Abstract Full Text Full Text PDF PubMed Scopus (245) Google Scholar Concurrently, leaflet remodeling techniques continue to evolve and nonresectional approaches10Woo Y.J. MacArthur J.W. Simplified nonresectional leaflet remodeling mitral valve repair for degenerative mitral regurgitation.J Thorac Cardiovasc Surg. 2012; 143: 749-752Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar,11Cevasco M. Myers P.O. Elbardissi A.W. Cohn L.H. Foldoplasty: a new and simplified technique for mitral valve repair that produces excellent medium-term outcomes.Ann Thorac Surg. 2011; 92: 1634-1638Abstract Full Text Full Text PDF PubMed Scop