title: A simple way to treat mitral valve prolapse: chordal replacement using a new mitral leaflet retractor.
abstract: OBJECTIVE
  The most difficult aspect of chordal replacement during mitral valve repair is to determine the correct length of the new chordae. A simple technique of chordal replacement was developed employing the new mitral leaflet retractor that enables easy adjustment of the length of artificial chordae.
  
  
  METHODS
  For prolapse of the anterior mitral leaflet (AML), the level of the normal opposing posterior leaflet can be used to determine the length of new chordae. We developed a double-headed leaflet retractor with which both mitral leaflets can be retracted simultaneously at the same level. This retractor makes it easy to tie the slippery Gore-Tex sutures for artificial chordae adjusting the length of the new chordae on AML to the level of the opposing normal posterior leaflet. We employed this retractor for the creation of artificial chordae in 55 consecutive patients with degenerative AML prolapse between 2005 and 2013. A ring annuloplasty was concomitantly performed to stabilize the reconstruction.
  
  
  RESULTS
  We had no hospital death. Follow-up was 100% complete with a mean follow-up duration of 1181 ± 839 (range 50-2892) days. Reoperation-free survival at 5 years was 98.2%. Freedom from moderate-to-severe mitral regurgitation was 88.0% at 5 years. At follow-up, all non-reoperated survivors were in New York Heart Association Class I or II.
  
  
  CONCLUSIONS
  We have reported the chordal replacement using the new double-headed mitral leaflet retractor. Our leaflet retractor is a convenient tool representing an easy creation of artificial chordae in mitral valve repair.
authors.affiliation: Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Kashiyama
authors.affiliation: Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan tmasai@watanabe-hsp.or.jp.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Masai
authors.affiliation: Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Yoshitatsu
authors.affiliation: Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamauchi
authors.affiliation: Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ogasawara
authors.affiliation: Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Matsunaga
authors.affiliation: Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002815:Chordae Tendineae / Q000503:physiopathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000295:instrumentation* / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anterior leaflet prolapse; Artificial chordae reconstruction; Mitral valve repair