Objectives: Replacement of diseased chords with Gore-Tex sutures (neochords) in patients with
degenerative mitral valve insufficiency has become a standard technique used by surgeons
in mitral valve repair with good long-term results. Nevertheless, determining the
correct length of the neochordae has remained problematic. Moreover, the nature of
the suture material and the tendency of the knot to slide may result in in difficulty
in establishing the correct length of the neochordae. The novel Livanova 3D Rechord
ring with an additional chordal guiding system allows a quick “semi-automatic” sizing
of the neochordae and prevents the “sliding” of knots. We investigated the efficacy
of the Livanova 3D Rechord ring in patients with mitral ring and neochord repair.
Methods: A matched pair analysis of retrospectively collected data of patients underwent mitral
valve repair between January 2014 and December 2016 was undertaken. 20 Patients received
mitral valve repair using neochords and Livanova 3D Rechord ring were matched with
20 patients with mitral valve repair with neochordae and implantation of CE Physio
II ring. Pre- intra- and early postoperative as well as echocardiographic data were
analyzed. All values are given as mean ± SD, p < 0.05 was considered statistically significant.
Results: All procedures could be performed successfully without residual or with trivial mitral
insufficiency. Preoperative characteristics did not differ between the groups. There
was one in-hospital death in the CE Physio ring group. Concomitant operations included
3 tricuspid valve reconstructions, 3 single CABG as well as 2 MAZE operations. Aortic
cross-clamp time (85 ± 24 vs. 112 ± 22 minute, p = 0.004) and cardiopulmonary bypass time (126 ± 35 vs. 175 ± 45 minute p < 0.00001) were significantly reduced in the group with Livanova 3D Rechord ring.
The average number of implanted neochords was also significantly lower in the Livanova
3D Rechord ring group (1.85 ± 0.67 vs. 2.7 ± 1.55 p < 0.002).
Conclusion: The use of the novel Livanova 3D Rechord ring is safe and provides excellent functional
results. The chordal guiding system markedly reduces the time of the procedure by
facilitating sizing and knotting and reducing the number of necessary neochords to
achieve valve competence. Although the long-term durability of mitral repair with
this type of semirigid annuloplastic ring warrants further validation, our current
clinical data are encouraging.
