Abstract
This study aimed to evaluate the clinical utility of a novel mitral valve repair technique, the Referring to the Anterior, Fixing on the Frontal (RAFF) method, which improves anatomical precision and enhances the reproducibility of loop-type artificial chordae ("neochordae") reconstruction. This retrospective study included 67 individuals who underwent isolated, elective mitral valve repair with neochordae between 2019 and 2024. Participants were divided into the RAFF (n = 36) and non-RAFF (n = 31) groups. In the RAFF technique, chordal length is determined by referencing the anterior leaflet chordae from the ipsilateral papillary muscle, with loop sets anchored to the frontal head of the papillary muscle. Leaflet resection was not performed in any case. Baseline demographics and lesion characteristics were similar between groups. The RAFF group demonstrated significantly less residual mitral regurgitation at the conclusion of surgery (p = 0.014). Use of the RAFF method was significantly associated with suppression of postoperative leaflet billowing and a lower recurrence rate of moderate or greater mitral regurgitation during follow-up. Frontal fixation of posterior leaflet neochordae, a defining feature of the technique, resulted in a significant increase in coaptation length without inducing systolic anterior motion or elevating transvalvular gradients. The method also significantly reduced aortic cross-clamp time without compromising hemodynamic performance. The RAFF technique offers a standardized and anatomically guided approach to neochordae reconstruction. It minimizes inter-surgeon variability and anatomical inconsistencies, and promotes durable mitral competence by optimizing leaflet coaptation without incurring adverse events.