Innovative Mitral Valve Repair Using Chordal Transfer Technique Saves Patient from Lifelong Anticoagulation Therapy

Introduction:
In a remarkable procedure, Professor Zhang Jing and his team at the Department of Cardiothoracic Surgery successfully performed a mitral valve repair using the chordal transfer technique on a 66-year-old patient suffering from chronic heart failure. This groundbreaking surgery not only corrected the underlying cause of the patient's recurrent heart failure—mitral valve prolapse with severe regurgitation—but also preserved the patient's own mitral valve, eliminating the need for lifelong anticoagulation therapy and reducing the risks associated with valve replacement.

Case Overview:
Mr. Wang, a 66-year-old male, had been hospitalized multiple times over the past few months due to worsening heart problems, which significantly impacted his quality of life. After seeking treatment at our hospital, he was diagnosed with mitral valve prolapse and severe regurgitation, along with tricuspid valve regurgitation. These conditions were causing his heart to work harder, ultimately leading to heart failure.

The mitral valve is one of the four main valves in the heart, responsible for ensuring the unidirectional flow of blood from the left atrium to the left ventricle. When the supporting tendinous cords (chordae tendineae) that help close the valve deteriorate or rupture, the valve leaflets fail to close properly, resulting in blood flowing backward into the atrium. This puts additional strain on the heart, causing it to enlarge and weaken over time, ultimately leading to heart failure.

Mr. Wang’s heart was overwhelmed, and surgery was urgently needed.

Innovative Approach: Mitral Valve Repair with Chordal Transfer

The clinical team was faced with a choice between valve replacement and valve repair. A valve replacement would have meant removing the damaged valve and replacing it with an artificial one. This would require lifelong anticoagulation therapy, with associated risks of bleeding and thrombosis, as well as dietary and lifestyle restrictions.

Focusing on improving Mr. Wang’s long-term quality of life, Professor Zhang Jing, the hospital’s Vice President and Director of the Heart Center, made the decision to proceed with mitral valve repair rather than replacement. This decision was more challenging but offered a far better outcome for the patient.

The key to the success of the procedure was the chordal transfer technique. The chordae tendineae, which are fine yet incredibly strong fibers that control the closing of the valve leaflets, were transferred from the posterior leaflet to the anterior leaflet to restore the valve’s closure function. This technique allowed the patient’s original mitral valve to be preserved while correcting the prolapse and eliminating the regurgitation.

Under the close collaboration of the anesthesia, extracorporeal circulation, and surgical teams, Professor Zhang successfully completed the surgery. Postoperative echocardiography showed that the mitral valve regurgitation had completely resolved, and the valve was functioning normally.

Advantages of Mitral Valve Repair

Professor Zhang explained: "For patients with appropriate indications for mitral valve disease, mitral valve repair is the internationally recognized first-line treatment. This procedure preserves the heart’s natural structure and function, allowing patients to avoid the lifelong burden of anticoagulation therapy and significantly improving their postoperative quality of life."

Conclusion:
This innovative approach not only successfully addressed Mr. Wang's heart failure but also provided him with the benefit of retaining his natural valve, improving his quality of life without the need for lifelong medication or the risks associated with valve replacement.