title: Is minimally invasive mitral valve repair with artificial chords reproducible and applicable in routine surgery?
abstract: OBJECTIVE
  Traditional resectional techniques and chordal transfer are difficult to apply in video-assisted mitral valve repair. Using artificial chords appears easier in this setting. The purpose of this study was to review the effectiveness and reproducibility of neochordal repair as a routine approach to minimally invasive mitral repair, and to assess the stability of neochord implantation using the figure-of-eight suture without pledgets in this setting.
  
  
  METHODS
  This is a retrospective review of all patients who underwent minimally invasive video-assisted mitral valve repair from 2008 to 2013. The primary endpoints were recurrent mitral regurgitation and reoperation.
  
  
  RESULTS
  A total of 426 consecutive patients were included during the study period, with a mean age of 55 ± 18 years. Neochords were used in all patients, and in association with leaflet resection in 47 patients. One patient was not repairable and underwent valve replacement (repair rate, 99.8%). Fifteen patients had Grade I (3.5%) regurgitation, whereas the remainder had none. Patients were fast-tracked, with 25% extubated in the operation theatre and the remainder within 6 h. There were 5 deaths within 30 days (1.2%). Follow-up ranged 3-60 months, during which all of the patients remained with no or trace mitral regurgitation. No de-insertion or rupture of any neochords was found, and no patients required a reoperation.
  
  
  CONCLUSIONS
  Minimally invasive mitral valve repair using neochords provided a high rate of repair, reproducible results in a routine cardiac surgery setting and stable repair during follow-up. This has become our preferred technique for mitral valve surgery.
authors: Center for Minimally Invasive Cardiac Surgery, Geneva, Switzerland Cardiovascular Surgery, Geneva University Hospitals & School of Medicine, Geneva, Switzerland Clinic for Cardiac Surgery, Hygeia Hospital, Athens, Greece a.panos@bluewin.ch.
authors: Aristotelis
authors: A
authors: Panos
authors: Clinic for Cardiac Surgery, Hygeia Hospital, Athens, Greece.
authors: Sylvio
authors: S
authors: Vlad
authors: Clinic for Cardiac Surgery, Hygeia Hospital, Athens, Greece.
authors: Fotios
authors: F
authors: Milas
authors: Cardiovascular Surgery, Geneva University Hospitals & School of Medicine, Geneva, Switzerland.
authors: Patrick O
authors: PO
authors: Myers
mesh_terms: D000328:Adult; D000368:Aged; D002815:Chordae Tendineae / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality
keywords: Minimally invasive cardiac surgery; Mitral valve repair; Neochords; Video-assisted