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Effect Of Neo-chord Angulation On Chordal Force During Mitral Valve Prolapse Repair: An In Vitro Study
Vahid Sadri1, Keshav Kohli1, Jorge H Jimenez1, William S Cranford1, Abigail R Berry1, Daniel Grinberg2, W Randolph Chitwood3, Ajit P Yoganathan1.
1Georgia Institute of Technology, Atlanta, GA, USA, 2H˘pital Louis Pradel, Lyon, France, 3East Carolina University, Greenville, NC, USA.

OBJECTIVE: Artificial chordae treatment is an important repair technique, but the optimal anchoring position is unknown. This study examined whether the different ventricular anchoring locations affect forces in three neo-chordae used for mitral valve repair.
METHODS: Seven porcine mitral valves were mounted in a left heart simulator with normal and hypertensive systolic pressures and physiologic flow through the valves. Neo-chordae were anchored at either the left ventricular apex, papillary muscle base, or papillary muscle tip. The neo-chordae were then inserted at three sites along the P2 leaflet segment (P1side-p2, P2center, P3side-p2). Each neo-chord suture was instrumented with a chordal force transducer. Mitral regurgitation was induced by cutting posterior marginal chordae, and the forces on neo-chordae required to restore a normal mitral valve coaptation were quantified for different ventricular anchoring origins and leaflet insertion sites.
RESULTS: The results of this study showed that under normotensive conditions, the force exerted was much higher at P2center than either P1side-p2 or P3side-p2. Moreover, the total neo-chordae force across all sutures was the same irrespective of the ventricular anchoring origin. Also, forces on both the P1side-p2 and P3side-p2 were not statistically different. The same trend was also observed in the hypertensive model.
CONCLUSIONS: Across all anchoring configurations, artificial neo-chordae were effectively utilized to remove mitral regurgitation. The central leaflet neo-chordae had a much higher force applied during systole than the neo-chordae at the perimeters. In a well-tensioned neo-chordae (no slack), the anchoring location does not affect total chordal tension.


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