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Richard C. Daly
Kenton J. Zehr
Giovanni Speziali
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J Thorac Cardiovasc Surg 2009;137:188-193
© 2009 The American Association for Thoracic Surgery

Evolving Technology

Beating-heart, off-pump mitral valve repair by implantation of artificial chordae tendineae: An acute in vivo animal study

Pietro Bajona, MDa, William E. Katz, MDb, Richard C. Daly, MDc, Kenton J. Zehr, MDa, Giovanni Speziali, MDa,*

a Division of Cardiothoracic Surgery, Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
b Department of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
c Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minn

Received for publication August 1, 2008; revisions received August 1, 2008; accepted for publication September 1, 2008.

* Address for reprints: Giovanni Speziali, MD, University of Pittsburgh, Division of Cardiac Surgery–HLESI, 200 Lothrop St, Suite C-700, Pittsburgh, PA 15213. (Email: spezialig{at}upmc.edu).

Objective: To evaluate the effectiveness of a new off-pump mitral valve repair technology in restoring valve competency in a porcine model of acute mitral regurgitation.

Methods: Acute mitral regurgitation was induced in 6 anesthetized pigs by cutting anterior leaflet chordae. Artificial chordae were then transapically implanted on the prolapsing segment under epicardial echocardiographic guidance and secured outside the left ventricular apex. All intracardiac manipulations were performed off-pump, through a stab wound incision on the left ventricular apex.

Results: Cutting the anterior leaflet chordae caused an eccentric, posteriorly directed jet of mitral regurgitation that could be visualized by color Doppler sonography. Implantation of chordae through the left ventricular apex completely eliminated valve regurgitation in 4 animals and reduced regurgitation in 2. Intraoperative measurement of artificial chordal tensions gave similar values to those reported for native chordae.

Conclusions: Off-pump, transapical implantation of artificial chordae between a prolapsing anterior mitral valve leaflet and the left ventricular apex was effective in reducing acutely induced mitral regurgitation. Long-term studies are planned to assess the stability in this animal model.

Abbreviations and Acronyms ACTs = artificial chordae tendineae; LV = left ventricular; MR = mitral regurgitation; MV = mitral valve; MVP = mitral valve prolapse






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