Quantitative biomechanical optimization of neochordal implantation location on mitral leaflets during valve repair

Utilization of Engineering Advances for Detailed Biomechanical Characterization of the Mitral–Ventricular Relationship to Optimize Repair Strategies: A Comprehensive Review

“…Given that increasing the leading-edge distance too much would result in a decreased leaflet coaptation length, Pandya and colleagues ultimately found that, from a biomechanical point of view, insertion of artificial chords at 6 mm from the leading edge and with a width of 10 mm would be the optimal configuration. However, all the suture pull-out forces observed in their experiments vastly exceeded the forces usually observed for the primary or secondary chordae tendineae [159]. A recent study by Fernández and colleagues showed that different techniques of anchoring the neochords at the papillary muscles may influence neochordal biomechanics; however, this is not the case when reviewing the loading conditions within the physiological range [160].…”

“…The location of neochord placement during surgical repair can also have different effects on how the forces are balanced in between the valve and ventricle and may have a significant impact on the long-term durability of the repair. Ex vivo bioreactor studies investigating the suture anchoring width and leading-edge distance demonstrated that increases in the suturing anchor width and a larger distance to the leading edge both increased the suture pull-out force [159]. Given that increasing the leading-edge distance too much would result in a decreased leaflet coaptation length, Pandya and colleagues ultimately found that, from a biomechanical point of view, insertion of artificial chords at 6 mm from the leading edge and with a width of 10 mm would be the optimal configuration.…”

Neochords: How long, how many, too many?

“…By varying both the location of the neochord with respect to the leaflet’s leading edge and the suture anchoring width, we demonstrated that increasing the suture width up to 10 mm significantly increased the suture pullout force. 15 It should be noted that the width of the leaflet anchoring suture is limited by the number of neochordae implanted, as well as the necessity of avoiding inadvertent plication of the leaflet. Increasing the distance of the leaflet anchoring suture from the leading edge also increases the pullout force threshold, although to a lesser degree than increasing the suture width.…”

“…Increasing the distance of the leaflet anchoring suture from the leading edge also increases the pullout force threshold, although to a lesser degree than increasing the suture width. 15 Although this study was isolated to the posterior leaflet, a surgeon should exercise caution when applying these findings to the anterior leaflet because increasing the distance from the leading edge may shift the coaptation line anteriorly, which can increase the risk of systolic anterior motion (SAM).…”

Chordal force profile after neochordal repair of anterior mitral valve prolapse: An ex vivo study

“…It is therefore essential to obtain a better understanding of the biomechanical and hemodynamic influence of residual MR on the anterior leaflet post-MV repair. We developed an ex vivo left heart simulator that allowed us to quantitatively analyze valvular biomechanics and hemodynamics and elucidated the underlying clinically relevant mechanisms in mitral disease models, including models of degenerative MR, 17 , 18 , 19 , 20 , 21 mitral annular dilatation, 22 , 23 ischemic MR, 24 papillary muscle rupture, 25 Barlow's disease, 26 and rheumatic MV stenosis. 27 Throughout this series of fiber Bragg grating- (FBG) related studies, chordae linked to a prolapsed leaflet enduring a greater force than in a repaired state or at baseline, has been consistently demonstrated.…”