**8.4 New device**

In our Cardiothoracic Surgery Center we worked out our own device to measure proper length of chords and multiple loops formation (Figure 21).

Fig. 21. Boldyrev – Barbukhatty- Porhanov device.

The gist of the given model is that on the end of the working body we placed props located perpendicularly to the plane of the graduated scale and fitted with circular cuttings for loop fixation, and on a scale there is a core clamp.By means of our appliance one is able to perform at the same time intraoperative measurement of the chordal apparatus and to generate necessary quantity of loops for chord prosthetic repair. This device is in process of patenting in the Russian Federation (request № 2011101697\14(002183), January 18, 2011)

#### **8.5 South Russian experience**

Material and Methods: From 2008 to 2011 we have treated 30 patients with moderately severe (3+) or severe (4+) mitral regurgitation. Echocardiographic findings are showed in the Table 6.


Table 6. Preoperative echocardiographic data.

They all underwent MV chord system repair. There were 17 male and 13 female patients. Age range was from 16 to 70 years (mean age 55,3 ± 13). Mean ejection fraction was 49%, and minimal - 35% (3 cases). Etiology 20 (66%) patient had fibroelastoc deficiency, 2 (7%) ischemic heart disease, 3 ( 10%) had Barlow,s disease, 2 (7%) had Marfan,s disease, and 3 (10%) had mitral valve malformation. 7 (23%) patients were found to have posterior leaflet

In our Cardiothoracic Surgery Center we worked out our own device to measure proper

The gist of the given model is that on the end of the working body we placed props located perpendicularly to the plane of the graduated scale and fitted with circular cuttings for loop fixation, and on a scale there is a core clamp.By means of our appliance one is able to perform at the same time intraoperative measurement of the chordal apparatus and to generate necessary quantity of loops for chord prosthetic repair. This device is in process of patenting in the Russian Federation (request № 2011101697\14(002183), January 18, 2011)

Material and Methods: From 2008 to 2011 we have treated 30 patients with moderately severe (3+) or severe (4+) mitral regurgitation. Echocardiographic findings are showed in

They all underwent MV chord system repair. There were 17 male and 13 female patients. Age range was from 16 to 70 years (mean age 55,3 ± 13). Mean ejection fraction was 49%, and minimal - 35% (3 cases). Etiology 20 (66%) patient had fibroelastoc deficiency, 2 (7%) ischemic heart disease, 3 ( 10%) had Barlow,s disease, 2 (7%) had Marfan,s disease, and 3 (10%) had mitral valve malformation. 7 (23%) patients were found to have posterior leaflet

MV regurgitation grade by color Doppler 3 ± 0,44 Regurgitation volume, ml 109 ± 19,4 MV EF,% 57 ± 5,4 Left atrium size, mm 51,4 ± 6,8 Left ventricular end diastolic dimension, mm 60,9 ± 5,2 Left ventricular end diastolic volume, ml 199,5 ± 38,4 LV EF, % 49,2 ± 8,5 Pulmonary hypertension, mm Hg 49,2 ± 8,5

length of chords and multiple loops formation (Figure 21).

Fig. 21. Boldyrev – Barbukhatty- Porhanov device.

**8.5 South Russian experience** 

Table 6. Preoperative echocardiographic data.

the Table 6.

**8.4 New device** 

prolapse, 5 (17%) patients – bileaflet prolapse, and 18 (60%) – anterior leaflet prolapse. We performed 7 posterior mitral valve leaflet chord reconstructions, in 4 cases with multiple loops. Anterior mitral leaflet chord repair was carried out in 18 (60%) patients (including multiple loops in 10 cases). 5 (17%) patient had total AML chord repair ( Figure 22, 23).

Fig. 22. Patient Ch. Preoperative echocardiography (left, two-chambered position at the mitral valve level) and postoperative view (right, four-chambered position).

Fig. 23. Patient Ch. Intraoperative photo total anterior mitral leaflet chord repair.

Mitral Valve Subvalvular Apparatus Repair with Artificial Neochords Application 27

We believe the quantitative assessment of regurgitation described by Zoghbi and co-authors (Zoghbi W et al, 2003) is the most unbiased. In immediate postoperative period in 1 patient we noticed systolic anterior motion syndrome with further release. In the follow-up period ranging from 1 to 30 months, 1 patient required reoperation in 4 months for 3 + mitral regurgitation; the mechanism of recurrent mitral regurgitation showed AL chords tearing

On the basis of our results we state that artificial chords are rather attractive method for MV repair in patients with abnormal chord apparatus. Despite some difficulty while selecting proper neochords, this technique is applicable and reliable in most cases. Mitral valve repair is a challenging technique deserving continuous attention over time. In the future we are waiting for more novel procedures to ensure better results in mid and long term morbidity.

Barbukhatty К., Boldyrev S, Rossoha О, Strigina О, Sapunov V. Mitral valve subvalvular

Bizzarri F, Tudisco A, Ricci M, Rose D, Frati G (2010). Journal of Cardiothoracic Surgery

Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD,Gaasch WH,

The 10th Congress of Cardiovascular surgeons.

apparatus reconstruction with ePTFE sutures. Cardiovascular diseases. Baculev's SCCVS ballot of RAMS. Volume 11, #6, November – December, 2010, oral report.

Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise

off with high arterial hypertension ( Table № 8).

Table 8. Freedom from reoperation.

**9. Conclusions** 

**10. References** 

2010, 5:22

1(3%) patient underwent total chordae replacement (anterior and posterior leaflets). We applied quadrangular resection with leaflet height adjustment of posterior leaflet for bileaflet prolapses with AMV chord repair. When we carried out repair with multiple loops we used a device (proper modification) to measure length and formation of neochords. To make multiple loops we followed the sequence showed in Figure 24.

Fig. 24. Scheme of multiple loops performance (from A to E).

All patients underwent suturing annuloplasty or were implanted supporting rings MedIng. Results: All patients survived. Operative results were assessed by echocardiography (Table 7).


Table 7. Postoperative echocardiographic data.

We believe the quantitative assessment of regurgitation described by Zoghbi and co-authors (Zoghbi W et al, 2003) is the most unbiased. In immediate postoperative period in 1 patient we noticed systolic anterior motion syndrome with further release. In the follow-up period ranging from 1 to 30 months, 1 patient required reoperation in 4 months for 3 + mitral regurgitation; the mechanism of recurrent mitral regurgitation showed AL chords tearing off with high arterial hypertension ( Table № 8).

Table 8. Freedom from reoperation.

#### **9. Conclusions**

26 Front Lines of Thoracic Surgery

1(3%) patient underwent total chordae replacement (anterior and posterior leaflets). We applied quadrangular resection with leaflet height adjustment of posterior leaflet for bileaflet prolapses with AMV chord repair. When we carried out repair with multiple loops we used a device (proper modification) to measure length and formation of neochords. To

make multiple loops we followed the sequence showed in Figure 24.

Fig. 24. Scheme of multiple loops performance (from A to E).

Table 7. Postoperative echocardiographic data.

All patients underwent suturing annuloplasty or were implanted supporting rings MedIng. Results: All patients survived. Operative results were assessed by echocardiography (Table 7).

MV regurgitation grade by color Doppler 1,14 ± 0,8 Regurgitation volume, ml 20 ± 11,8 MV EF,% 20 ± 11,8 Left atrium size, mm 42,6 ± 4,2 Left ventricular end diastolic dimension, mm 51,8 ± 7,4 Left ventricular end diastolic volume, ml 51,8 ± 7,4 LV EF, % 54,6 ± 9,6 Pulmonary hypertension, mm Hg 34,8 ± 7,1 On the basis of our results we state that artificial chords are rather attractive method for MV repair in patients with abnormal chord apparatus. Despite some difficulty while selecting proper neochords, this technique is applicable and reliable in most cases. Mitral valve repair is a challenging technique deserving continuous attention over time. In the future we are waiting for more novel procedures to ensure better results in mid and long term morbidity.
