Tips for Use of Novel Method for Easy Adjustment of Appropriate Artificial Chordae Length in Patients Undergoing Mitral Valve Repair

Hiroyuki Nishi, Kimihiro Kurose, Tetsuya Saito, Keita Inoguchi, Toshiki Takahashi

Department of Cardiovascular Surgery, Osaka, Police Hospital, Osaka, Japan

Date, time and location: 2018.05.25 10:30, Exhibition area, 1st Floor. Zone – D

Abstract

OBJECTIVE: In patients who require mitral valve repair, it is difficult to determine the appropriate length of artificial chordae. The Memo 3D Rechord, a complete prosthetic ring associated with a temporary chordal guide system comprised of yellow loops that function as a reference guide for automatically determining the height of neo-chordae. However, it is impossible to readjust its position after removal of the yellow loops. We sought to evaluate our tips for use of this system.

METHODS: Twenty-seven patients (15 males, mean 67.3±9.5years old) who underwent mitral valve repair using artificial chordae with the Memo Rechord were evaluated. Initially, the center of the anterior leaflet was determined following careful inspection. Next, ePTFE sutures were passed through the papillary muscles and the free margin of the prolapsed leaflet, then appropriate positioning of the PTFE chordae was performed using a saline test. The PTFE chordae were passed through the loops and the free margin of the prolapsed leaflet was brought to the posterior annulus. Then, the PTFE sutures were tied and the temporary loop system removed.

RESULTS: Seven patients had anterior leaflet prolapse, while 16 had posterior and 4 bileaflet prolapse. The base of the loops was attached to the anterior papillary muscle in 9 patients and posterior in 23, with the other end attached to the anterior leaflet in 8, and posterior in 19. The number of artificial chordae was 1 in 5 cases, 2 in 16 cases, 3 in 5 cases, and 4 in one case. All mitral valve repairs were performed successfully. Postoperative echocardiography MR grade was none in 5, grade I in 20, and grade I-II in 2 patients.

CONCLUSIONS: Using our technique, mitral valve repair for leaflet prolapse with the Memo 3D rechord is a simple and reproducible method.