Feasibility of mitral valve repair using the loop technique

Purpose: The most difficult aspect of chordal replacement in a mitral valve repair using expanded polytetrafluoroethylene (ePTFE) sutures, is determining the appropriate length of artificial chorda and ligation of the ePTFE sutures without the knot sliding. Patients and Methods: We adopted a loop technique reported by Mohr et al. in 12 consecutive cases from October 2005. Nine cases were comparative broad-range prolapses of the posterior leaflet, 2 cases were anterior and the posterior leaflet and 1 case was vegetation of the anterior leaflet. Chordal replacement was done by 4 loops in 11 cases and by 8 loops in 1 case. Results: Postoperative echocardiography showed more physiological movement of the posterior leaflet than by the resection suture method. When comparing of the peak pressure gradient across the mitral valve on echocardiography between the loop technique group and the nonloop technique group, the gradient in the loop technique group (n=11) was 1.8±0.7 mmHg and in the non-loop technique group (n=18) was 3.2±1.0 mm Hg. There was a significant statistical difference between 2 groups. The loop technique also seemed to be superior procedure hemodynamically. Conclusion: This technique may be useful through both port-access minimally invasive cardiac surgery (MICS) and a conventional approach to the mitral valve, and simplifying chordal replacement. We report on the feasibility of the loop technique based on our experience.