Minimal Invasive MV Repair with Loop Technique

Mitral valve repair is the gold standard treatment for degenerative mitral valve (MV) regurgitation, and minimally invasive access allows for excellent exposure of the MV and subvalvular apparatus while minimizing surgical trauma. The use of polytetrafluoroethylene neochordae for replacement of ruptured chordae tendineae was introduced over twenty years ago (1). The so-called loop technique with the use of premeasured and premade neochordae especially facilitates minimal invasive MV repair (2). Depending on the commercially available product, a set of three or four loops is fixed to the respective papillary muscle head. Each loop is then sewed on to the prolapsing segment of the mitral valve around 8-10 mm off the free edge. The complete prolapsing segment is resuspended with neochordae. In order to complete the repair, an annuloplasty ring is placed in a standard fashion. In summary, the loop technique enables a straightforward MV repair with an excellent outcome, including normal leaflet mobility and a large MV orifice area (3). 

References

1. David TE. Replacement of chordae tendineae with expanded polytetrafluoroethylene sutures. J Card Surg. 1989;4(4):286-290.
2. von Oppell UO, Mohr FW. Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops. Ann Thorac Surg. 2000;70(6):2166-2168.
3. Falk V, Seeburger J, Czesla M, et al. How does the use of polytetrafluoroethylene neochordae for posterior mitral valve prolapse (loop technique) compare with leaflet resection? A prospective randomized trial. J Thorac Cardiovasc Surg. 2008;136(5):1205.