The Novel Livanova 3D Rechord Semirigid Ring Facilitates Mitral Valve Repair with Artificial Chords: A Matched Pair Analysis

Objectives: Replacement of diseased chords with Gore-Tex sutures (neochords) in patients with degenerative mitral valve insufficiency has become a standard technique used by surgeons in mitral valve repair with good long-term results. Nevertheless, determining the correct length of the neochordae has remained problematic. Moreover, the nature of the suture material and the tendency of the knot to slide may result in in difficulty in establishing the correct length of the neochordae. The novel Livanova 3D Rechord ring with an additional chordal guiding system allows a quick “semi-automatic” sizing of the neochordae and prevents the “sliding” of knots. We investigated the efficacy of the Livanova 3D Rechord ring in patients with mitral ring and neochord repair.

Methods: A matched pair analysis of retrospectively collected data of patients underwent mitral valve repair between January 2014 and December 2016 was undertaken. 20 Patients received mitral valve repair using neochords and Livanova 3D Rechord ring were matched with 20 patients with mitral valve repair with neochordae and implantation of CE Physio II ring. Pre- intra- and early postoperative as well as echocardiographic data were analyzed. All values are given as mean ± SD, p < 0.05 was considered statistically significant.

Results: All procedures could be performed successfully without residual or with trivial mitral insufficiency. Preoperative characteristics did not differ between the groups. There was one in-hospital death in the CE Physio ring group. Concomitant operations included 3 tricuspid valve reconstructions, 3 single CABG as well as 2 MAZE operations. Aortic cross-clamp time (85 ± 24 vs. 112 ± 22 minute, p = 0.004) and cardiopulmonary bypass time (126 ± 35 vs. 175 ± 45 minute p < 0.00001) were significantly reduced in the group with Livanova 3D Rechord ring. The average number of implanted neochords was also significantly lower in the Livanova 3D Rechord ring group (1.85 ± 0.67 vs. 2.7 ± 1.55 p < 0.002).

Conclusion: The use of the novel Livanova 3D Rechord ring is safe and provides excellent functional results. The chordal guiding system markedly reduces the time of the procedure by facilitating sizing and knotting and reducing the number of necessary neochords to achieve valve competence. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.