Loop-in-loop technique in mitral valve repair via minithoracotomy

Although multiple neochordae creations with premeasured loops by polytetrafluoroethylene (PTFE) sutures is a feasible and effective technique for mitral valve repair by an endoscopic-assisted minithoracotomy approach, measuring the correct length of premeasured loops is difficult because of diversity of the distance between the papillary muscle and the prolapsed mitral leaflet. A new technique consisted of a premade primary loop set and a secondary loop to adjust the length of the neochordae was devised as a loop-in-loop technique. Facilitating tying a slippery PTFE suture as the secondary loop in a correct position, a knot fixation using a neurosurgical titanium clip was applied.