An Endoscopic Systematic Approach to Different Size P2 Prolapses Using a Modified Loop Technique.

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Mitral Valve Disease

Background:

• The standard mitral loop repair technique (premeasured neochords) may not adequately address varying P2 prolapse sizes.
• Larger mitral valve prolapses can lead to residual prolapse or regurgitation, especially after ventricular remodeling causes neochordal pseudo-elongation.

Purpose of the Study:

• To investigate the effect of P2 prolapse size on neochordal anchoring location.
• To modify the mitral loop technique to account for P2 prolapse size, aiming to prevent residual prolapse and regurgitation.

Main Methods:

• Reviewed surgical footage of 50 endoscopic mitral valve repairs involving P2 neochords using a modified loop technique.
• Measured P2 prolapse size intraoperatively (edge-to-annulus distance) and adjusted neochordal anchoring incrementally farther from the leaflet edge for larger prolapses.
• Utilized echocardiography for immediate and 3-month follow-up.

Main Results:

• All 50 repairs were successful, with no residual prolapse or regurgitation exceeding mild severity.
• Consistent neochordal leaflet anchoring distances were observed based on prolapse size: Grade 1 (<1.5 cm) = 3 mm, Grade 2 (1.5-2 cm) = 5-8 mm, Grade 3 (2-3 cm) = 1-1.5 cm, Grade 4 (>3 cm) = 1.5-2 cm.
• The modified technique successfully prevented suboptimal leaflet anchoring across all prolapse sizes.

Conclusions:

• The adapted loop technique, incorporating P2 prolapse size, effectively prevents residual mitral valve prolapse and billowing.
• This modification ensures appropriate neochordal anchoring, leading to successful mitral valve repair outcomes.