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J Thorac Cardiovasc Surg 2007;134:1072-1073
© 2007 The American Association for Thoracic Surgery

Brief Communication

A novel technique of utilizing artificial chordae for repair of mitral valve prolapse

Marcio Scorsin, MD, PhDa,*, Nawwar Al-Attar, FRCS, PhDb, Arrigo Lessana, MDc,1

a Unita Operativa di Cardiochirurgia, Villa Maria Pia Hospital, Turin, Italy
b Service de Chirurgie Cardiaque, Hôpital Bichat, Paris, France
c Centre Cardiologique du Nord, St Denis, France.

Received for publication May 6, 2007; accepted for publication June 1, 2007.

* Address for reprints: Marcio Scorsin, MD, PhD, Villa Maria Pia Hospital, Strada Mongreno, 180, 10132 Turin Italy. (Email: mscorsin{at}hotmail.com).


Figure 1
Drs Scorsin, Lessana, and Al-Attar (left to right)


Mitral valve repair provides excellent long-term results and superior survival compared with those of valve replacement in the management of mitral regurgitation and should be considered whenever possible.1Go Despite the existence of a variety of standardized techniques of surgical repair, it is performed in only one half of the cases.2Go Technically, repair of posterior leaflet prolapse (PLP) is less complex, with excellent long-term results, compared with those of anterior leaflet prolapse (ALP) or bileaflet prolapse. In either case, the feasibility and durability of mitral valve repair remain highly dependent on surgical experience.3Go

We propose a new approach to extend repair techniques to extensive and complex valve prolapse. From September 2006 to February 2007, 9 patients with severe mitral regurgitation caused by severe ALP or PLP underwent valve repair with an artificial chordae system device. Preoperative cardiac magnetic resonance imaging and/or perioperative transesophageal echocardiography determined the ideal chordae length required to manufacture the device, which was constructed perioperatively.

Clinical Summary

During chest opening and cardiopulmonary bypass installation, the chordae system is manufactured according to preoperative measurements. The device is composed of 2 sets of 4 artificial chordae (4-mm polytetrafluoroethylene sutures; Gore Tex, WL Gore & Associates, Flagstaff, Ariz) attached to a 3-mm strip of knitted polyester (Bard Sauvage, Tempe, Ariz) 18 mm wide, leaving 4 mm between each chorda (simulating the edge of the cusp). In the other extremity, 1 single point is fused and from that 2 stitches arise with 2 needles at the extremity (Figure 1).


Figure 1
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  		Figure 1. The device reproduces the chordae system. The number of chordae and their length can be adapted to surgical needs.

 
The device is applied by suturing the strip to the free edge of the prolapsed leaflet by continuous suture. Each array is anchored to the tip of the correspondent papillary muscle by only 1 stitch. Systolic stress is therefore evenly distributed over both papillary muscles and across the free mitral edge. Two lengths (22 and 25 mm) of the chordae system were used in our series to repair ALP in 6 patients and PLP in 3 patients. A prosthetic annuloplasty ring was inserted in all patients. Nine-month follow-up echocardiograms showed no mitral regurgitation in 7 patients and mild mitral regurgitation in 2 patients.

Discussion

Correction of mitral insufficiency from PLP is frequently feasible with established repair techniques. On the other hand, repair of ALP is associated with a higher risk of reoperation, and with bileaflet prolapse the success rate of achieving repair has been reported to be as low as 40%, with some authors advising in such cases to replace the valve directly.3Go

We present a novel approach to treat complex or difficult mitral leaflet prolapse. It is easily reproducible and based on the simplification of 2 well-established techniques: chordal transfer for treatment of ALP4Go and conventional replacement of chordae tendineae with polytetrafluoroethylene sutures.5Go It alleviates surgical interference with valve components, chordal length manipulation, or annular plication and preserves the natural anatomy and integrity of the mitral valve. The artificial chordae system homogenously fixates the entire prolapsed leaflet at an ideal distance from each of the 2 papillary muscles, thus equilibrating the systolic stress without delicate measurements or complicated knotting of individual artificial chordae. The encouraging results in this short series are to be confirmed with long-term follow-up studies.

Footnotes

1 Arrigo Lessana is co-owner with Dr Scorsin of a patent on the device described in this report. Back

References

  1. Braunberger E, Deloche A, Berrebi A, et al. Very long-term results (more than 20 years) of valve repair with Carpentier’s techniques in nonrheumatic mitral valve insufficiency. Circulation 2001;104(suppl I):I-8-I-11.[Medline]
  2. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003;24:1231-1243.[Abstract/Free Full Text]
  3. Hayek E, Gring CN, Griffin BP. Mitral valve prolapse. Lancet 2005;365:507-518.[Medline]
  4. Lessana A, Scorsin M, Romano M, et al. Transposition of posterior leaflet for treatment of ruptured main chordae of the anterior mitral leaflet. J Thorac Cardiovasc Surg 1985;89:804-806.[Abstract]
  5. David TE. Artificial chordae. Semin Thorac Cardiovasc Surg 2004;16:161-168.[Medline]



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A. Doi, H. Iida, and T. Sunazawa
Intracardiac Calipers for Artificial Chordae Replacement in Mitral Valve Repair
Ann. Thorac. Surg., January 1, 2009; 87(1): 326 - 328.
[Abstract] [Full Text] [PDF]

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