Biomechanical drawbacks of different techniques of mitral neochordal implantation: When an apparently optimal repair can fail

摘要: Abstract Objectives Intraoperative assessment of the proper neochordal length during mitral plasty may be complex sometimes. Patient-specific finite element models were used to elucidate biomechanical drawbacks underlying an apparently correct repair for isolated posterior prolapse. Methods Preoperative patient-specific derived from cardiac magnetic resonance images; integrated with intraoperative surgical details assess location and extent prolapsing region, including number type diseased chordae; complemented by properties leaflets, chordae tendineae, artificial neochordae. We investigated postoperative valve biomechanics in a wide spectrum different techniques (single neochorda, double neochordae, preconfigured loop), all reestablishing adequate valvular competence, but differing suboptimal millimetric expanded polytetrafluoroethylene suture lengths range ±2 mm, compared corresponding "ideal repair." Results Despite absence residual regurgitation, alterations chordal forces leaflet stresses arose simulating repairs; increasingly relevant as more prolapse anatomies considered worst when single neochorda implantation. Multiple implantations less sensitive errors tuning, associated hampered asymmetric configurations reproduced. Computational outcomes consistent presence entity recurrent regurgitation at midterm follow-up simulated patients. Conclusions Suboptimal tuning significantly alters stresses, which key parameters determining long-term outcome repair. The comparison suggests possible criteria selection implementation neochordae implantation techniques.