Simplifying Mitral Valve Repair with Novel Premeasured Chordal Loops

Background: The "respect" approach to surgical mitral valve repair, which involves implanting artificial neochordae, is gaining increased adoption. Surgeons are possibly prone to error in the manual construction of neochordae, which can lead to prolonged cross-clamp times. Novel systems such as Chord-X Pre-Measured Loops (On-X Life Technologies, Inc., Austin, TX, USA) eliminate the need for manual neochordae construction, potentially simplifying the mitral repair procedure. However, clinical data on its use are currently limited to a small publication. Methods: We conducted a retrospective cohort study to evaluate the use of Chord-X loops in 40 consecutive patients who underwent surgery in Geelong, Victoria, Australia, between May 2020 and February 2024. Three surgeons participated in this study. Results: All patients were referred for severe mitral valve regurgitation secondary to myxomatous degeneration, with P2 prolapse being the most common pathology. Chord-X Pre-Measured Loops effectively corrected a variety of leaflet pathologies, including bi-leaflet disease, with a single set of loops sufficing in most patients. Intraoperative and follow-up echocardiographic assessments revealed no greater than mild mitral regurgitation in any patient, with 75% exhibiting no or trace mitral regurgitation. Conclusions: The Chord-X Pre-Measured Loops system demonstrated safety, efficacy, and reproducibility across all patients. Surgeons were able to easily adopt this technology without requiring additional training. We believe this technology offers a safe option for surgeons performing low-volume mitral repair surgeries.