Robotically-assisted mitral valve repair—chordal replacement with Gore-Tex loops

The loop technique, devised by Mohr (Leipzig, Germany) almost 25 years ago, eliminated the risk of knot slippage when tying Gore-Tex neochords, and its use has become widespread in videoassisted 'mini mitral' valve repair, especially in Europe. It facilitates both simple and complex mitral valve reconstruction of all aetiologies with favourable valve haemodynamics (lower transmitral gradient and larger orifice area compared to leaflet resection), a low rate of recurrent mitral regurgitation and very durable longterm results. However, there is a paucity of data in the surgical literature about the use of Gore-Tex loops in robotic mitral valve repair, including modified techniques to measure the length of the loops in the totally endoscopic environment. It is also a common misconception that once the loop length is chosen, it cannot be altered whereas in reality fine tuning of the 'effective loop length' with millimetre levels of accuracy allows perfect symmetry of the valve closure line to be achieved. We report our techniques for using Gore-Tex loops during robotic mitral valve surgery with particular emphasis on length measurement and adjustment. The greater use of the loop technique in robotic mitral valve repair will hopefully allow patients with increasingly complex valves to benefit from totally endoscopic surgery.