Innovative tool to guide mitral valve repair: Methods and perspective

Despite an increasing prevalence, mitral valve surgery outcomes for primary mitral regurgitation are heterogeneous in term of repair rate, technics, and results. Repair procedures are driven by an intraoperative morphological visual and echocardiographic assessment. Repair success still relies mainly on surgeon's expertise. Recent technological outbreaks can be used to develop innovative tools enable measurement of physical parameters during these surgeries. The tension applied on artificial chordae during transapical beating-heart implantation of neochordae can be measured. The data obtained provide novel insights on subvalvular apparatus pathophysiology and suggest the key role of a strong and homogeneous coaptation for biomechanical homeostasis of the mitral apparatus. A bidimensional mapping of coaptation forces can also be obtained during conventional mitral valve surgeries (open heart surgeries with cardiopulmonary bypass). This method provides a precise real-time assessment of coaptation surface and of the repartition of these forces all along this surface. These two examples illustrate the concept of “surgery based on physical measurement” associated with usual morphological assessment. If the concept of “low-stress repair” is intuitively seducing, the prognostic value of such measurement remains to be evaluated through clinical studies with long-term follow-up in order to move forward to a clinical use.