| Abstrakt: |
Background: Artificial chordae implantation has become the most applied method for mitral valve repair. Choosing the proper length of the neochords is the most crucial point in this technique. In order to give the possibility of reversibility and corrections, the authors developed a novel technique in which the lengths of the neochords are determined at the end of the repair by moving a small pericardial lock along the neochords while the shape and competence of the valve is tested. In this simple reproducible technique, the length of the neochords remains adjustable until the very last moment of the repair and is fixed only when the final water test confirms ideal configuration. Methods: Between 2017 and 2023, 123 patients with severe degenerative MR underwent MV repair with pericardial lock technique. 83(67.4%) had pure posterior leaflet prolapse, 24(19.5%) had pure anterior leaflet prolapse and in 17(13.8%) Both leaflets were involved. Minimally invasive approach was used in 106(86.1%) patients. Determining the number and location of the necessary neochords was made after the initial classic valve analysis. The neochords were passed through appropriate papillary muscles and then left alone until the final step, after placing the suitable annuloplasty ring. After passing through the leaflet edges, the neochords were passed twice through a small 2 x 4 mm piece of pericardium. These pericardial locks can move along the neochord with moderate resistance which offers the possibility of adjustment to find the best suitable configuration of the leaflet confirmed by water tests. Results: The median follow up time was 34.3 months. The mean number of neochords used for each patient was 2.57 ±0.99 (1-6). Most patient received neochords on P2(82), followed by A2(36), p3(32), A3(26), p1(24), and A1(10). There was no mortality in patients. One patient was reoperated and repaired 8 months after surgery for severe MR due to anterior leaflet perforation at the site of annuloplasty suture. There was one mild MR and one Moderate MR in the early echocardiography, both with fibroelastic deficiency and small anterior leaflets. Significant MR(moderate or more) was seen in 6(4.8%)patients during follow up while 25 (20.3%) had mild MR and 82 (66.6%) had no or trivial MR. Conclusion: The pericardial lock technique is simple and reproducible with the advantage of secure fixation, and the possibility of correction of neochord length. Adjustability and reversibility until the last stage of the repair, increases the confidence and security of the surgeon and at the same time guaranties the most proper configuration and geometry of the valve. [ABSTRACT FROM AUTHOR] |
