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Endoscopic placement of multiple artificial chordae with robotic assistance and nitinol clip fixation  J. Michael Smith, MD, Hubert Stein, BSc, BME  The.

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1 Endoscopic placement of multiple artificial chordae with robotic assistance and nitinol clip fixation  J. Michael Smith, MD, Hubert Stein, BSc, BME  The Journal of Thoracic and Cardiovascular Surgery  Volume 135, Issue 3, Pages (March 2008) DOI: /j.jtcvs Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 The neochordae platform is secured with extracorporeal knots tied by the patient side assistant using a closed knot pusher. Right robotic large needle holder maintains a suture gap between the muscle head and the polytetrafluoroethylene (Gore-Tex; WL Gore & Associates Inc, Flagstaff, Ariz) knot to avoid cutting off the papillary muscle by overtightening the anchor stitches on the loop platform. The atrial retractor (top) provides deep subvalvular exposure. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Two sets of neochordae anchored on the posterior surface of the anterolateral papillary muscle and the posteromedial papillary muscle for repair of a large P2 prolapse. The multiple loops going up from the platform are clearly visible. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 U-clip device (Medtronic Inc, Minneapolis, Minn) (red, release trigger: blue, braided member: green, needle: orange) is placed in the leaflet with a robotic large needle holder, and the neochordae loop (white) is captured in the open clip circle. In this patient, the leaflet edge is folded toward the ventricle before deploying the U-clip device to achieve additional reduction of the leaflet height. The “ski-tip”–style ends of the robotic atrial retractor blades are lodged into the anterior leaflet, and the papillary muscles are visualized clearly. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

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