• Daniel Grinberg, Pierre-Jean Cottinet, Sophie Thivolet, David Audigier, Jean-Fabien Capsal, Minh-Quyen Le, and Jean-François Obadia.
• Department of Adult Cardiac Surgery, Hôpital cardiologique Louis Pradel, Lyon Medical School, Bron, France; Univ Lyon, INSA-Lyon, LGEF (Lab of electrical engineering and ferroelectricity), Villeurbanne, France; Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY. Electronic address: daniel.grinberg.pro@gmail.com.
• J. Thorac. Cardiovasc. Surg. 2019 Sep 1; 158 (3): 746-755.

ObjectivesComplex structure of mitral valve and its central position in the heart limit assessment of mitral function to standardized calculated parameters assessed using medical imaging (echocardiography). Novel techniques, which allow mitral valve repair (MVr) in a beating heart, offer the opportunity for innovative objective assessment in physiologic and pathologic conditions. We report, to our knowledge, the first data of real-time chordal tension measurement during a transapical neochordae implantation.MethodsSeven patients with severe degenerative mitral regurgitation due to posterior prolapse underwent transapical MVr using the NeoChord DS 1000 (NeoChord Inc, Minneapolis, Minn). During prolapse correction, the tension applied on the neochordae was measured in addition to hemodynamic and echocardiographic parameters.ResultsThe traction applied on 1 chorda sustaining the P2 segment was measured at between 0.7 and 0.9 N, and oscillated with respiration. When several neochordae were set in tension, this initial tension was spread homogeneously on each chorda (mean sum of the amplitude of tension 0.98 ± 0.08 N). To achieve an optimal echocardiographic correction, a complementary synchronous traction on all chordae was required. During this adjustment, the sum of the tension decreased (mean 12 ± 2%; P = .018), suggesting that when normal physiology was restored, the valvular apparatus was in a low-stress state. This method allowed us to apply a precise and reproducible technique, leading to a good procedural success rate with a low morbidity and mortality rate.ConclusionsThe tension applied on chordae during transapical implantation of neochordae for degenerative mitral regurgitation can be measured, providing original data about the objective consequences of MVr on the mitral apparatus.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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