Quantitative biomechanical optimization of neochordal implantation location on mitral leaflets during valve repair. JTCVS techniques Pandya, P. K., Wilkerson, R. J., Imbrie-Moore, A. M., Zhu, Y., Marin-Cuartas, M., Park, M. H., Woo, Y. J. 2022; 14: 89-93


Objective: Suture pull-out remains a significant mechanism of long-term neochordal repair failure, as demonstrated by clinical reports on recurrent mitral valve regurgitation and need for reoperation. The objective of this study was to provide a quantitative comparison of suture pull-out forces for various neochordal implantation locations.Methods: Posterior leaflets were excised from fresh porcine mitral valves (n=54) and fixed between two 3-dimensional-printed plates. Gore-Tex CV-5 sutures (WL Gore & Associates Inc) were placed with distances from the leading edge and widths between anchoring sutures with values of 2mm, 6mm, and 10mm for a total of 9 groups (n=6 per group). Mechanical testing was performed using a tensile testing machine to evaluate pull-out force of the suture through the mitral valve leaflet.Results: Increasing the suture anchoring width improved failure strength significantly across all leading-edge distances (P<.001). Additionally, increasing the leading-edge distance from 2mm to 6mm increased suture pull-out forces significantly across all suture widths (P<.001). For 6-mm and 10-mm widths, increasing the leading-edge distance from 6mm to 10mm increased suture pull-out forces by an average of 3.58±0.15N; in comparison, for leading-edge distances of 6mm and 10mm, increasing the suture anchoring width from 6mm to 10mm improves the force by an average of 7.09±0.44N.Conclusions: Increasing suture anchoring width and leading-edge distance improves the suture pull-out force through the mitral leaflet, which may optimize postrepair durability. The results suggest a comparative advantage to increasing suture anchoring width compared with leading-edge distance.

View details for DOI 10.1016/j.xjtc.2022.05.008

View details for PubMedID 35967240