title: Mitral valve repair with loop technique via median sternotomy in 180 patients.
abstract: OBJECTIVE
  Artificial chordal reconstruction technique uses several expanded polytetrafluoroethylene loops to achieve mitral valve repair.
  
  
  METHODS
  We studied retrospectively 180 patients who underwent mitral valve repair using the loop technique via median sternotomy: 86 for posterior leaflet prolapse, 48 for anterior leaflet prolapse and 26 for bileaflet prolapse.
  
  
  RESULTS
  Of the 180 patients, 138 required 1 loop set; 40 patients required 2 and 2 patients with Barlow's disease required 3. Loop sets contained two to nine loops ranging in length from 14 to 26 mm. Additional techniques required to ensure complete repair using the loop technique included commissural edge-to-edge suture in 78 patients, loop-in-loop technique for extension of the artificial loop in 18 and use of needle-side sutures in 18. Systolic anterior leaflet motion was observed in only 2 patients (1.1%). One patient with immune deficiency died of sepsis. Predischarge echocardiograms showed no or trace mitral regurgitation (MR) in 160 patients (89%), mild MR in 17 patients (9.4)% and mild-to-moderate MR in 3 patients (1.7%). Only 1 patient required redo operation due to recurrent MR freedom from MR greater than moderate was seen in 98.0 ± 1.4% of patients at 1 year, 91.5 ± 2.8% of patients at 3 years, and 91.5 ± 2.8% at 5 years postoperatively. No significant difference was seen in the rate of recurrence of MR among the sites of prolapsing leaflets.
  
  
  CONCLUSIONS
  The loop technique via median sternotomy to treat posterior, anterior and, especially, bileaflet prolapse provided satisfactory mid-term outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan shibata-cvs@zeus.eonet.ne.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shibata
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Motoki
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Akimasa
authors.initials: A
authors.lastname: Morisaki
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nishimura
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hattori
mesh_terms: D000368:Aged; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000453:epidemiology / Q000601:surgery; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*
chemical_list: D011138:Polytetrafluoroethylene
keywords: Loop technique; Mitral valve regurgitation; Mitral valve repair