Chordal transposition for anterior mitral prolapse: early and long-term results

Abstract

Chordal transposition is an effective and easily carried out technique for the correction of anterior mitral prolapse. The presence of a complex pathology or posterior chordal elongation do not rule out the procedure. The absence of annular calcification is important in order to obtain a satisfactory correction.

Very long-term durability of the edge-to-edge repair for isolated anterior mitral leaflet prolapse: Up to 21 years of clinical and echocardiographic results

“…17 Several different surgical techniques have been described to treat ALP. [3][4][5][6][7][8]18 At our institution, this lesion has been preferentially corrected by EE approximation of the anterior and posterior leaflet at the site of the regurgitant jet. 8 We have previously reported the results of this technique at a median follow-up of 3.1 years.…”

“…1,2 In the presence of severe MR due to prolapse or flail of the anterior mitral leaflet (ALP), several different methods of repair have been used, including triangular resection, chordal shortening, chordal transfer, artificial chordae implantation, papillary muscle repositioning, and the edge-to-edge (EE) technique. [3][4][5][6][7][8] Since 1991, at our institution, segmental prolapse of the anterior leaflet involving only 1 scallop has been preferentially corrected with a ''functional'' rather than an ''anatomic'' repair using EE approximation of the anterior and posterior leaflet at the site of the regurgitant jet. 8 We have previously reported the results of this technique at a median follow-up of 3.1 years.…”

Guided Functional Re-Engineering of the Mitral Valve Leaflets

“…Chordal transfer is performed in patients with myxomatous disease and involves the transfer of chords from a healthy portion of the leaflet to the prolapsing one. This technique has demonstrated excellent clinical outcomes (Smedira et al, 1996;Salati et al, 1997;Duran et al, 1999;Gillinov et al, 2005a). Shortening of the anterior leaflet (Quigley et al 2005), or anterior leaflet chord (Dreyfus et al, 2006), have also been used.…”

“…Current treatment strategies for MV dysfunction include MV repair and replacement. Repair is the gold standard and usually employs synthetic biomaterials, such as expanded polytetrafluoethylene (ePTFE), for chordal reconstruction, or chemically-treated xenograft tissue, such as pericardium, for annular, cuspal or chordal reconstruction (Salati et al, 1997;Bevilaqua et al, 2003;Acar et al, 2004;David et al, 2013). Both approaches only deliver inert or biocompatible material solutions that cannot regenerate or grow with the patient.…”

Neo-chordae length adjustment in mitral valve repair

“…This method has first been mentioned by David and colleagues [1,2]. Thereafter several techniques have been advocated for length adjustment including chordal transfer with or without partial annuloplasty [3] and chordal shortening [4], and all have been described and applied successfully with a low operative mortality and minimum postoperative complications. We have adopted the technique which was described by David and colleagues [1,2] and devised a new approach in an attempt to ease the repair.…”