Artificial chordae for degenerative mitral valve disease: critical analysis of current techniques

Abstract

The surgical repair of degenerative mitral valve disease involves a number of technical points of importance. The use of artificial chordae for the repair of degenerative disease has increased as a part of the move from mitral valve replacement to repair of the mitral valve. The use of artificial chordae provides an alternative to the techniques pioneered by Carpentier (including the quadrangular resection, transfer of native chordae and papillary muscle shortening/plasty), which can be more technically difficult. Despite a growth in their uptake and the indications for their use, a number of challenges remain for the use of artificial chordae in mitral valve repair, particularly in the determination of the correct length to ensure optimal leaflet coaptation. Here, we analyse over 40 techniques described for artificial chordae mitral valve repair in the setting of degenerative disease.

Choosing the “Best” surgical techniques for mitral valve repair: Lessons from the literature

“…Although the resectional techniques demonstrate excellent results with low mortality, the durability of valve repair does decline over time . Neochord repair restores normal leaflet coaptation without creating excessive leaflet stress and provides excellent durability; some suggest that durability with chordal replacement techniques may exceed that achieved with leaflet resection . To date, however, data suggest equivalence between resection and chordal replacement in the management of posterior leaflet prolapse …”

“…Chordal loops should not cross the middle of the valve as they extend from the papillary muscle to the leaflet edges. This technique has been applied successfully by several groups (Figure ) …”

Transapical beating-heart chordae implantation in mitral regurgitation: a new horizon for repairing mitral valve prolapse

“…In a recent randomized controlled trial, the use of loop neo-chords for correcting posterior mitral valve prolapse resulted in similar clinical and echocardiographic outcomes, but greater line of coaptation, as compared to conventional leaflet resection techniques (16). Until recently, replacement of chords has required open-heart surgery with bypass to stop the heart during the procedure (17).…”

Quantitative Modeling of the Mitral Valve by Three-Dimensional Transesophageal Echocardiography in Patients Undergoing Mitral Valve Repair: Correlation with Intraoperative Surgical Technique

“…Parameters in red are the parameters that correlated best with intraoperative technique in our study. 4,13,20,[22][23][24]27,[33][34][35][36][37] NA, Currently no available data.…”