Implante de neocuerdas con una medida estándar para reparación de la válvula mitral

Abstract

IntroductionMitral valve repair with polytetrafluoroethylene neochord is currently the gold standard of treatment, based on the respect rather than resect approach. Different challenging and complicated techniques have been developed to measure the exact length of the neochord. Our objective is to describe the loop technique with a standard measurement in mitral repair. Materials and methodsA descriptive study was conducted on a retrospective cohort of 34 consecutive patients, from January 2011 to October 2017. All patients underwent the implanting of a neochord using an in-house loop technique. The length of the neochord was pre-measured with 15mm for the posterior leaflet and 25mm for the anterior leaflet, based on the echocardiographic measurements of other authors. An evaluation was made of valvular competence at the weaning of extracorporeal circulation using transoesophageal echocardiography was evaluated, with an early follow-up with transthoracic echocardiography. ResultsThe video-assisted mini-thoracotomy approach was performed in 70.5% (24/34) of cases, and by conventional sternotomy in 29.4% (10/34). The anterior leaflet was repaired in 26.4% (9/34), the posterior in 61.7% (21/34), and both in 11.7% (4/34). Annuloplasty was performed with a rigid ring in 79.4%, and semi-rigid in 20% of cases. The mean ring size was 29.9±2.0. The intraoperative echocardiogram did not show any grade of failure in 82.3% (28/34), and mild insufficiency in 17.6% (6/34). No patient undergoing minimally invasive surgery required conversion. The extracorporeal circulation time was 158±38minutes and clamping 116±31min. No patient required resection or adjustment of the neochord measurement or conversion to replacement. There were 2cases of hospital mortality; the first due to hypovolaemic shock and the second due to septic shock of pulmonary origin. In the early follow-up with a mean of 8 months (1-40), 82.3% (28/34) did not present with mitral regurgitation, and 17.6% (6/34) had grade I insufficiency. ConclusionThe proposed technique with preformed loops of polytetrafluoroethylene neochord with standardised measurement showed reliable preliminary results. Studies with long-term follow-up would be necessary.