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A new simplified technique for artificial chordae implantation in mitral valve repair with its early results.

ABSTRACT: Background:Many techniques in mitral valve repair (MVR) have been reported with successful long-term results. The aim of this study is to present our simplified technique in artificial chordae replacement for MVR, and reporting its short-term outcomes. Methods:We present a prospective single-surgeon experience. A new simplified artificial chordae implantation technique has been used to repair mitral valves. Postoperative echocardiography at 0, 6, then every 12 months is used to control the results. Endpoints involved freedom from mitral regurgitation (MR), reoperation and major adverse cardiac and cerebrovascular events (MACCE). Results:Between 01/2016 and 01/2018, 57 consecutive patients undergo MVR using this technique are evaluated. Mean age was 63.6±10.1 years and 68.4% were male. Mitral valve pathology was mainly degenerative (52, 91.2%) or healed endocarditis (5, 8.8%). Besides chordae replacement (3.6±1.1 per patient), annuloplasty was used in all patients to correct annulus dilation and stabilize the repair. Mean cross-clamping time was 53±13.4 minutes in isolated MVR and 69.4±31.1 minutes in concomitant procedures. Postoperative outcomes reported two mortalities. Discharge echocardiography reported mild MR in 4 patients and the rest of patients had non-to trace regurgitation. Follow-up results within a mean of 19.3±8.5 months reported no significant MR or need for reoperation and three more (non-valve related) mortalities. Conclusions:Our simplified technique allows to reduce the number of used chordae and re-correction if needed, which consequently reduces cross-clamping and bypass time especially in endoscopic MVR. Good intraoperative and short-term results are reported. These results are still under investigation to prove long-term stability of the repair.

SUBMITTER: El Gabry M

PROVIDER: S-EPMC7138970 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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A new simplified technique for artificial chordae implantation in mitral valve repair with its early results.

El Gabry Mohamed M Mourad Fanar F Loosen Lisa L Ruhparwar Arjang A Demircioglu Ender E Wendt Daniel D Jakob Heinz H Shehada Sharaf-Eldin SE

Journal of thoracic disease 20200301 3

<h4>Background</h4>Many techniques in mitral valve repair (MVR) have been reported with successful long-term results. The aim of this study is to present our simplified technique in artificial chordae replacement for MVR, and reporting its short-term outcomes.<h4>Methods</h4>We present a prospective single-surgeon experience. A new simplified artificial chordae implantation technique has been used to repair mitral valves. Postoperative echocardiography at 0, 6, then every 12 months is used to co ...[more]

PMID: 32274138

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Project description:BackgroundRobotic mitral repair is generally performed with four intercostal trocars and a minithoracotomy. We describe our technique and results with a totally-thoracoscopic closed chest approach using a 12 mm valveless trocar as "working port", without a minithoracotomy. We compared our results with this technique with a control group of robotic mitral repairs performed earlier with a minithoracotomy.MethodsReview of all patients with degenerative mitral valve disease who underwent robotic mitral valve repair surgery since December 2019 (n = 110). Patients with concomitant procedures (n = 8) were excluded. The remaining 102 patients were divided in two groups, depending on the approach used, minithoracotomy (n = 63) and totally thoracoscopic (n = 39).ResultsThere were no significant differences between groups regarding preoperative characteristics. All procedures were completed robotically as planned, and repair rate was 100%. The minithoracotomy group showed a higher percentage of leaflet resections (17.9% vs. 38.7%; p = 0.03). All surgical times were significatively reduced in the totally thoracoscopic group: Cardiopulmonary bypass (97 vs. 115 min, p = 0.0008), ischemic time (67 vs. 80 min, p = 0.0013) and total surgical time (185 vs. 225 min; p < 0.00001). There were no differences in ICU length of stay (1 day, p = 0.07) but hospital length of stay was shorter in the totally thoracoscopic group (4 days; p = 0.0001). Postoperative complications were similar between groups. MR at discharge was mild or less in all cases.ConclusionsRobotic mitral repair for degenerative disease can be safely performed as a closed-chest procedure, using a 12 mm trocar as "working port" and avoiding the need for a minithoracotomy. This approach does not seem to negatively affect the quality of the procedure by any measure, providing similar excellent clinical outcomes and repair rate. All surgical times were shorter in the closed-chest group.

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A new simplified technique for artificial chordae implantation in mitral valve repair with its early results.

Publications

A new simplified technique for artificial chordae implantation in mitral valve repair with its early results.

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