Louis A. Brunsting, III, Ricardo E. Orozco, J. Scott Rankin, Robert S. Binford.
Centennial Medical Center, Nashville, TN, USA.
Background: Artificial chordal replacement has emerged as a superior method of mitral repair, with excellent early and late efficacy in our series. It is also ideal to combine with robotic techniques for correction of mitral prolapse.
METHODS: In this video, a patient with isolated posterior leaflet prolapse was approached with the latest generation DaVinci robotic system and endo-aortic balloon occlusion. After a pledgetted anchor stitch was placed in the posterior papillary muscle, a 2-o Gortex suture was passed through the anchor pledget, and a full ring was sutured to the mitral annulus. The Gortex suture then was woven into the prolapsing segment and positioned temporarily with the robotic forceps. The chord was repeatedly adjusted until testing demonstrated a competent valve, and then tied securely.
RESULTS: The procedure (incorporating chordal adjustment as the final step) produced complete competence by intraoperative valve testing, and the operation was concluded. Postoperative transesophageal echo showed a large surface area of coaptation and no residual leak. The patient recovered uneventfully.
CONCLUSIONS: Robotic artificial chordal replacement (without leaflet resection) is a reproducible procedure that simplifies mitral repair for prolapse. Early and late outcomes have been shown to be excellent. It is suggested that most patients with simple prolapse might validly be approached in this manner.
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