Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.
Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.
Ann Thorac Surg. 2018 Jun;105(6):1784-1789. doi: 10.1016/j.athoracsur.2017.12.030. Epub 2018 Feb 3.
Artificial chord implantation has become one of the most applied techniques for mitral valve repair (MVR). Many techniques have been described, with the goal of optimizing neochord implantation. A new annuloplasty device designed to simplify the determination of the appropriate neochord length has been recently introduced. We describe our initial experience with this new device.
The semirigid device is equipped with removable loops on the posterior aspect of the ring. Neochords are tied to the loops, which are subsequently removed. The device was implanted in 47 symptomatic patients from January 2015 to August 2016 through a median sternotomy in 33 patients (70.2%) and a right anterolateral minithoracotomy in 14 (29.8%). The cause of mitral valve insufficiency was degenerative in all patients, and most patients presented with isolated prolapse of the posterior leaflet. Before and after cardiopulmonary bypass, all patients underwent evaluation with transesophageal echocardiography, and transthoracic echocardiography was performed at discharge.
A median of 2 neochords were implanted (minimum, 1; maximum, 6). Mean cardiopulmonary bypass time and aortic cross-clamp times were 141.7 ± 32.3 and 104.8 ± 28.5 minutes for combined and 133 ± 53.9 and 98.3 ± 41.6 minutes for isolated MVR. At discharge, echocardiography revealed no or only mild mitral insufficiency in 45 patients (mean gradient, 2.9 ± 1.3 mm Hg).
This new annuloplasty ring facilitated determination of appropriate neochord length and was used to successfully treat different degenerative pathologies affecting both leaflets. This new device simplified length determination of the neochords.
人工腱索植入已成为二尖瓣修复（MVR）最常用的技术之一。已经描述了许多技术，目的是优化新腱索的植入。最近引入了一种新的瓣环成形术装置，旨在简化确定合适新腱索长度的过程。我们描述了我们使用这种新装置的初步经验。
半刚性装置在环的后侧面配备了可移动的环。新腱索系在环上，然后将其移除。该装置于 2015 年 1 月至 2016 年 8 月通过正中胸骨切开术在 33 例（70.2%）和右前外侧小开胸术在 14 例（29.8%）患者中植入。所有患者二尖瓣关闭不全的原因均为退行性，大多数患者表现为后叶孤立性脱垂。在体外循环前后，所有患者均接受经食管超声心动图评估，出院时进行经胸超声心动图检查。
中位数植入 2 根新腱索（最少 1 根，最多 6 根）。体外循环和主动脉阻断时间的平均值分别为联合 MVR 的 141.7 ± 32.3 分钟和 104.8 ± 28.5 分钟，以及单纯 MVR 的 133 ± 53.9 分钟和 98.3 ± 41.6 分钟。出院时，45 例患者超声心动图显示无或仅轻度二尖瓣关闭不全（平均梯度 2.9 ± 1.3mmHg）。
这种新的瓣环成形术环有助于确定合适的新腱索长度，并成功治疗了影响两个瓣叶的不同退行性病变。这种新装置简化了新腱索长度的确定。
