Early and mid-term results of mitral valve repair using premeasured Gore-Tex loops (‘loop technique’)☆

Kuntze, Thomas; Borger, Michael A.; Falk, Volkmar; Seeburger, Joerg; Girdauskas, Evaldas; Doll, Nicolas; Walther, Thomas; Mohr, Friedrich W.

doi:10.1016/j.ejcts.2008.01.013

Cited by 69 publications

(52 citation statements)

References 24 publications

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“…It does not reduce the surface of the leaflets, as compared to leaflet resection, hence it allows larger surface of coaptation at the end of the procedure. As a matter of fact, neochordae implantation is also being used during minimally invasive and even robotic assisted procedures [9,10].…”

Section: Discussionmentioning

confidence: 99%

Transapical endovascular implantation of neochordae using a suction and suture device☆

Maisano¹,

Michev²,

Rowe

et al. 2009

European Journal of Cardio-Thoracic Surgery

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Objective: Neochordae implantation is a standard method for treatment of mitral valve prolapse. We describe a transcatheter technology enabling transapical endovascular chordal implantation. Methods: Six adult pigs were anesthetized. Two 10F sheaths were introduced in the femoral vessels for monitoring and intracardiac echo. After midline sternotomy, the pericardium was opened, the apex was punctured inside two 2-0 polypropylene purse strings. A 0.035 in J tipped guidewire was introduced in the left ventricle and an ultra stiff 14F sheath (guide catheter) inserted through the apex. A suction-and-suture device was introduced in the left ventricle. The mitral valve was crossed under echo guidance. Using suction, either the anterior (two cases) or posterior (four cases) leaflet was captured and a loop of 4-0 polypropylene was thrown at the edge of the leaflet. The loop, with a pledget, was exteriorized through the introducer. The introducer was removed and the purse-string tied. Under echo guidance, the neochordae suture was pulled and tied over a pledget to evoke leaflet tethering. The animals were sacrificed and gross anatomy reviewed. Results: Leaflet capture was feasible in the intended location in all cases. Following suture tethering, variable degrees of MR were obtained. At gross anatomy, the neochordae were positioned at 1-4 mm from the leaflet free edge, and were firmly attached to the leaflets. Conclusions: Transcatheter endovascular neochordae implantation is feasible. A prolapse model is needed to further demonstrate feasibility under pathologic conditions. The apical approach allows easy and direct route to transcatheter beating heart minimally invasive mitral repair. #

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Section: Discussionmentioning

confidence: 99%

Transapical endovascular implantation of neochordae using a suction and suture device☆

Maisano¹,

Michev²,

Rowe

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…After the slack loop was refixed to the preferred position, the loop was strained. [1][2][3][4][5] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/AANJ/Vol00000/130254/APPFile/SG-AANJ130254.3d (AAN) [PREPRINTER stage] 3.19 kgÁmÁs À2 , respectively. 8 According to our traction test, the mean value of the tractive force when the UClips came off the papillary muscle was 8.55 kgÁmÁs À2 .…”

Section: Discussionmentioning

confidence: 99%

“…Mohr and von Oppell 3 reported a loop technique in which a loop unit (4 premeasured loops and a small pledget) is fixed on the prolapsed leaflet. 4 The loop technique makes it easier for the surgeon to repair the mitral valve. 5 Since we introduced the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) in 2005, it has been used for minimally invasive mitral valvuloplasty.…”

Section: Introductionmentioning

confidence: 99%

Dynamic evaluation of the loop technique using the U-Clip

Moriyama

Tomita

Watanabe

2013

Asian Cardiovasc Thorac Ann

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Background: We set out to evaluate mitral valve repair with the loop technique under dynamic conditions, using a U-Clip to anchor the loop unit to a papillary muscle. Methods: Mitral valve prolapse was artificially developed by resecting 4 chordae tendineae of a resected porcine heart. The loop unit was anchored to the papillary muscle using U-Clips. Each chordal loop was fixed on the prolapsed leaflet. A roller pump perfused the left ventricle. The left ventricular pressure was maintained at 250 mm Hg. Morphological assessment of the loop reconstruction was performed using an endoscope. Results: 10 independent chordal reconstructions were performed. In all cases, the loop unit remained anchored against pressures exceeding 250 mm Hg. Upon increasing the water filling volume, rupture of a chorda tendinea occurred in 7 cases, rupture of the papillary muscle occurred in 2 cases, and left ventricle rupture occurred in 1 case. In all rupture cases, the loop unit remained anchored to the papillary muscle. Conclusion: This dynamic evaluation of the loop technique using U-Clips to anchor the loop unit to a papillary muscle showed that the loop technique using U-Clips is a safe method.

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“…12,13 The minimally invasive technique for MV and TV surgery via a right anterolateral mini-thoracotomy has been described earlier by our group. [14][15][16][17] The technique of MV repair/replacement and the decision for or against additional TV repair was at the surgeon's discretion, depending on the preoperative and/or intraoperative echocardiography data.…”

Section: Methodsmentioning

confidence: 99%

Role of Tricuspid Valve Repair for Moderate Tricuspid Regurgitation during Minimally Invasive Mitral Valve Surgery

Pfannmueller

Verevkin

Borger

et al. 2013

Thorac cardiovasc Surg

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IntroductionThe decision as to whether or not concomitant tricuspid valve (TV) surgery should be performed in patients with left-sided valve surgery was influenced for many years by an article from Braunwald et al in 1967. 1 In this article, the authors concluded that tricuspid regurgitation (TR), in the presence of concomitant mitral valve (MV), would "… improve or disappear after MV replacement and that TV replacement is seldom necessary."However, several publications in the past 10 years have demonstrated that up to 74% of patients undergoing successful left-sided valve surgery will develop TR over time with poor outcomes. [2][3][4][5] In addition, TV-related reoperation is associated with an early mortality rate ranging between 0 and 37%.

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Early and mid-term results of mitral valve repair using premeasured Gore-Tex loops (‘loop technique’)☆

Abstract: MV repair with premeasured Gore-Tex loops results in excellent early- and mid-term outcomes for all types of leaflet prolapse. The loop technique facilitates minimal invasive MV repair without compromising surgical outcomes.

Cited by 69 publications

References 24 publications

Transapical endovascular implantation of neochordae using a suction and suture device☆

Transapical endovascular implantation of neochordae using a suction and suture device☆

Dynamic evaluation of the loop technique using the U-Clip

Role of Tricuspid Valve Repair for Moderate Tricuspid Regurgitation during Minimally Invasive Mitral Valve Surgery

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