Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 21;13(23):7029.
doi: 10.3390/jcm13237029.

Simplifying Mitral Valve Repair with Novel Premeasured Chordal Loops

Daniel Shell  1 , Natcha Bunwatcharaphan  1 , Michael Seitz  1 , Michael Rowland  1 , Manoras Chengalath  1 , Cheng-Hon Yap  1   2   3
Affiliations

Simplifying Mitral Valve Repair with Novel Premeasured Chordal Loops

Daniel Shell et al. J Clin Med. .

Abstract

Background: The "respect" approach to surgical mitral valve repair, which involves implanting artificial neochordae, is gaining increased adoption. Surgeons are possibly prone to error in the manual construction of neochordae, which can lead to prolonged cross-clamp times. Novel systems such as Chord-X Pre-Measured Loops (On-X Life Technologies, Inc., Austin, TX, USA) eliminate the need for manual neochordae construction, potentially simplifying the mitral repair procedure. However, clinical data on its use are currently limited to a small publication. Methods: We conducted a retrospective cohort study to evaluate the use of Chord-X loops in 40 consecutive patients who underwent surgery in Geelong, Victoria, Australia, between May 2020 and February 2024. Three surgeons participated in this study. Results: All patients were referred for severe mitral valve regurgitation secondary to myxomatous degeneration, with P2 prolapse being the most common pathology. Chord-X Pre-Measured Loops effectively corrected a variety of leaflet pathologies, including bi-leaflet disease, with a single set of loops sufficing in most patients. Intraoperative and follow-up echocardiographic assessments revealed no greater than mild mitral regurgitation in any patient, with 75% exhibiting no or trace mitral regurgitation. Conclusions: The Chord-X Pre-Measured Loops system demonstrated safety, efficacy, and reproducibility across all patients. Surgeons were able to easily adopt this technology without requiring additional training. We believe this technology offers a safe option for surgeons performing low-volume mitral repair surgeries.

Keywords: cardiac surgery; mitral regurgitation; mitral valve repair; neochordae; valvular heart disease.

PubMed Disclaimer

Conflict of interest statement

Cheng-hon Yap acts as a paid consultant for Edwards Lifesciences, Artivion, Zimmer Biomet, and Device Technologies. No other authors report relationships that could be construed as conflicts of interest.

Figures

Figure 1
Figure 1
Diagram of Chord-X Pre-Measured Loops system demonstrating the central pledget and attached ePTFE sutures. Used with the permission of Artivion, Inc., Kennesaw, GA, USA.
Figure 2
Figure 2
Intra-operative photography and TOE imaging demonstrating: (A) pledget fixation of the Chord-X system onto the posteromedial papillary muscle, (B) suturing of loops onto the P2 leaflet edge, (C) all loops attached to the P2 leaflet edge, and (D) mid-oesophageal long axis view post-repair exhibiting adequate coaptation of mitral valve; the neochord is faintly seen attaching to posterior aspect of the valve.
Figure 3
Figure 3
Distribution of the number of Chord-X sets and individual loops required per patient.
See this image and copyright information in PMC

References

    1. David T.E., David C.M., Lafreniere-Roula M., Manlhiot C. Long-Term Outcomes of Chordal Replacement with Expanded Polytetrafluoroethylene Sutures to Repair Mitral Leaflet Prolapse. J. Thorac. Cardiovasc. Surg. 2020;160:385–394.e1. doi: 10.1016/j.jtcvs.2019.08.006. - DOI - PubMed
    1. Sá M.P., Cavalcanti L.R.P., Van den Eynde J., Amabile A., Escorel Neto A.C., Perazzo A.M., Weymann A., Ruhparwar A., Sicouri S., Bisleri G., et al. Respect versus Resect Approaches for Mitral Valve Repair: A Study-Level Meta-Analysis. Trends Cardiovasc. Med. 2023;33:225–239. doi: 10.1016/j.tcm.2022.01.005. - DOI - PubMed
    1. Gillinov M., Quinn R., Kerendi F., Gaudiani V., Shemin R., Barnhart G., Raines E., Gerdisch M.W., Banbury M. Premeasured Chordal Loops for Mitral Valve Repair. Ann. Thorac. Surg. 2016;102:e269–e271. doi: 10.1016/j.athoracsur.2016.03.018. - DOI - PubMed
    1. Elde S., Woo Y.J. Neochords: How Long, How Many, Too Many? JTCVS Tech. 2023;22:59–64. doi: 10.1016/j.xjtc.2023.10.018. - DOI - PMC - PubMed
    1. Montanhesi P.K., Ghoneim A., Gelinas J., Chu M.W.A. Simplifying Mitral Valve Repair: A Guide to Neochordae Reconstruction. Innov. Technol. Tech. Cardiothorac. Vasc. Surg. 2022;17:343–351. doi: 10.1177/15569845221115186. - DOI - PMC - PubMed

LinkOut - more resources