A new method for artificial chordae length 'tuning' in mitral valve repair: Preliminary experience

Objectives Implanting expanded polytetrafluoroethylene neochordae is an established technique in treating complex mitral regurgitation. Difficulty in obtaining reliable preoperative and intraoperative measurements of an ideal neochordae length, as well as the unfeasibility of adjusting lengths once set in place with traditional techniques, led us to develop a system that allows rapid change of length after the evaluation of valve continence with hydrostatic tests. Methods The system consists of two components: a papillary component with arrest knots at constant intervals and a leaflet component with a reversible noose-lace to fix the loop to 1 of the knots on the papillary component. After implantation and coupling of the two components at a presumable optimal length, a prosthetic ring is sutured in place. Hydrostatic testing is then performed. Optimal chordae length can be obtained by releasing the noose-lace and sliding it over another fixing-knot. The adjustment can be performed as often as required without placing stress on the anatomic structures. Results Twenty patients underwent repair with this technique. No deaths or major adverse events occurred. All patients underwent echocardiography, both at discharge and 6 months after the operation. A total of 14 patients had no residual insufficiency, 5 patients had mild or trivial postoperative insufficiency without progression of regurgitation at the sixth month, and only 1 patient had mild insufficiency at discharge progressing to moderate insufficiency at the sixth month. Conclusion This new technique facilitates an otherwise complicated procedure. Short-term results are satisfactory, but further follow-up is required.