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Is The Minimally Invasive Mitral Valve Repair With Artificial Chords Reproducible And Applicable In Routine Surgery ?

BACKGROUND:Traditionally a variety of resectional techniques and chordae transfer are used for the repair of tha prolapsed segments. These techniques are difficult to apply in video-assisted mitral surgery. The application of artificial chordae in the setting of the video assisted mitral valve surgery allow for efficient repair.The purpose of this study was to demostrate the effectiveness and reproducibility of this method in the setting of routine surgery and assess the stability of the « figure of eight-without pledjet» implantation of the neochords in this setting. METHODS:From February 2008 to October 2013, 424 consecutive patients were operated under video assisted mitral valve repair for degenerative disease or healed endocarditis of the posterior, anterior or both leaflets. Were excluded the patients with stenotic mitral valve disease, active endocarditis, peripheral artery disease or previous right thorax surgery. Mean age was 55±18 years, LVEF of 60±8% and mean NYHA class II (87.5%). We have used in all patients neochordae and in 47 of them an association of leaflet resection and artificial chordae. RESULTS:Mean clamping time was of 106±28min and cardiopulmonary bypass time of 133±30 min. A very low incidence of residual leakage, grade I/IV (3.5%) were discovered postoperatively. Fifteen patients required multiple mitral repair attempts and had significantly longer cardiopulmonary bypass times with good final result. For 25% of the patients were fast track procedures with extubation on the operating table and the remain in the six post-operative hours. Hospital stay was 5 ± 1.3 days. No patient required reoperation. Five patients (1.2%) required re-exploration for bleeding. One patient had a permanent cerebral attack. The 30-day mortality was of 2.7%. Follow-up ranged from 3-60 months (trans-thoracic echocardiography at one month, 6 months and yearly after the operation) during which all of the patients remained with none or trace mitral valve regurgitation. No desinsertion or rupture of any chord loops was noticed. CONCLUSIONS:High rate of repair, reproducible results in the daily surgery and stable repair over the time are in favor of the use of the artificial chordae. Associated to the minimally invasiveness of the method is our preferred technique for mitral valve surgery.

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