Mitral Valve Repair of an A1-P1 Prolapse With the Chord-X System Through an Upper Mini Sternotomy and Atrial Rooftop Incision 

In this video, Dr Vince Gaudiani demonstrates how to perform an Onyx Chord-X chordal repair of a prolapsing medial commissure of the mitral valve. The patient had a prolapsing P1, which is caused prolapse of A1 as a result.    

First, Dr. Gaudiani cannulated the femoral vein, then performed an upper mini sternotomy before placing a right superior pulmonary vein vent and aortic cannulation with antegrade cardioplegia. The roof of the left atrium was then opened, and stay sutures were placed to optimize the view.  

Before assessing the valve, all the annuloplasty sutures were placed. Upon assessment, the P1 commissure was billowing anteriorly, and as a result, the A1 leaflet could not coapt against it, leading to prolapse as well. Three sets of chords were placed to hold the anterior and posterior leaflets down medially and create an excellent repair. 

After this, a  posterior annuloplasty ring was placed, and the atrium was closed to conclude the procedure. 

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