The modified technique of «leaflet folding» in replacement of chordae tendineae with polytetrafluoroethylene sutures in mitral valve repair

Objective. To evaluate the immediate results of a modified replacement of chordae tendineae for degenerative mitral valve lesions. Material and methods. There were 508 mitral valve repair procedures between 2007 and October 2021. Replacement of chordae tendineae was performed in 128 patients including a modified «leaflet folding» technique in 43 cases. We sutured fibrous part of one papillary muscle and edge of the prolapsed leaflet using PTFE thread. The leaflet was pulled to the mitral annulus, and preliminary fixation of neochord was performed by tying a double sliding knot. Length was adjusted by simply pulling the thread after hydraulic test. Length of neochords was fixed after annuloplasty and hydraulic test. Results. There were 43 surgeries. The sample included 27 men. Mean age of patients was 53.6±11.2 years, preoperative mitral regurgitation grade — 3—4. The causes of lesions included fibroelastic deficiency (n=36) and Barlow’s disease (n=7). Correction of posterior leaflet prolapse was performed in 31 cases, anterior leaflet — in 8 patients, both leaflets — in 4 cases. Mean number of neochords was 2.0±0.6 (1—4). There were no deaths or redo surgeries in early postoperative period. All patients were discharged. Mild regurgitation at discharge was observed in 8 patients. Other ones had no regurgitation. Conclusion. The proposed modification of «eaflet folding» technique provides good immediate results due to precise selection of neochord length. This technique is simple and can be recommended even for novice surgeons. However, long-term evaluation of results is necessary.