Artificial Chordal Replacement in Complex Mitral Valve Repair

By J. Scott Rankin, MD

Presented at the Society for Heart Valve Disease Meeting in Berlin, June 2009

This video reviews techniques of artificial chordal replacement (ACR) as a component of complex mitral repair. A brief summary of ACR history is given, as well as basic techniques of ACR placement and length adjustment. Several cases then are presented, and operative videos are correlated with pre- and post-operative transesophageal echocardiograms. Three procedures involving isolated posterior leaflet prolapse are shown, one repaired with open ACR, and two with robotic methods. Then, a patient with true commissural prolapse is illustrated, managed with ACR to both leaflets. A Barlow’s valve with annular calcification and generalized segmentation and prolapse is treated with annular decalcification and 4 sets of artificial chords. A patient with a previous failed repair underwent complex re-repair, including ACR to a prolapsing commissural cusp. Posterior leaflet augmentation with gluteraldehyde-fixed autologous pericardium also is used. Approaches to repairing valves with advanced rheumatic pathology are shown, including pericardial patches and ACR to replace diseased submitral segments. In hypertrophic obstructive cardiomyopathy, prolapsing papillary muscles can contribute to outflow tract obstruction. As a component of repair, obstructing papillary muscles are resected, and mitral leaflets reconstructed using ACR. Ischemic mitral regurgitation usually can be managed by full ring annuloplasty alone. However, some cases can manifest leaflet tethering or prolapse, which are repaired using pericardial patches and ACR. Finally, a case of tricuspid valve prolapse is presented, managed by ring annuloplasty and ACR. In summary, the advent and perfection of ACR techniques have contributed significantly to the applicability and durability of mitral valve repair.

Presented at the "Symposium on Mitral Valve Repair" at the Society for Heart Valve Disease Meeting in Berlin, June 2009.

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