Myxomatous Mitral Valve Repair: Loop Neochord Technique

Surgical repair techniques for myxomatous mitral regurgitation have evolved over time, with multiple different methods in current use. The loop neochord technique provides a versatile and reproducible method that can be used for anterior, posterior, or bileaflet prolapse, as well as Barlow’s disease. Preoperative planning and careful intraoperative valvular assessment are used to determine the appropriate loop length. Prefabricated commercial loops are available, but loops can also be created at the time of operation with polytetrafluroethylene 4-0 sutures and pledgets. We describe specific leaflet and subvalvular landmarks and suture placement techniques to ensure an accurate and durable mitral valve repair. Although these principles can be applied via a full sternotomy, we illustrate our preferred approach using the loop technique via a right minithoracotomy and femoral cardiopulmonary bypass.