Different ways to repair the mitral valve with artificial chordae: a systematic review

Abstract

Myxomatous mitral regurgitation (type II Carpentier's functional classification) affects about 1-2% of the population. This represents a very common indication for valve surgery resulting in a low percentage of repairs compared to replacement which is actually performed. In the last decades, several methods for mitral valve repair have been developed, to make the surgical feasibility easier, improve the long-term follow-up thus avoiding the need for reoperations. A very interesting method is represented by the combination of various valve repair techniques, depending on the involvement of the anterior, posterior, or both leaflets, and the use of PTFE artificial chordae tendineae when excessive chordal elongation or rupture due to myxomatous degeneration co-exists. The aim of this review is to summarize the evolution of these techniques from the beginning till now.

Basic Mechanisms of Mitral Regurgitation

“…Besides surgical techniques, the routine intra-op MV surgical use of transesophageal echocardiography (TEE) has contributed significantly to predicting, guiding and assessing successful MV repair: TEE imaging can determine MV annuloplasty ring size by measuring the anterior leaflet length and required neo-chord lengths, which is especially helpful in less invasive MV repair [76]. TEE can predict post MV repair development of systolic anterior motion (SAM, see below) based on LV cavity size <45mm in end-diastole, aorto-mitral angle <120 degrees, MV leaflet coaptation-septum distance <25 mm, posterior leaflet height >15 mm and basal septal diameter ≥ 15 mm [77, 78].…”

Mitral valve repair in dogs

“…Ideally artificial chordae length should match that of the opposing chordae to ensure proper coaptation of the opposing leaflets. Several methods, including application of a caliper, transesophageal echocardiography, and multiple knots 6,30,36,37 have been reported to ensure that artificial chordae are of the optimal length. However, these techniques may be difficult to apply to the hearts of smallbreed dogs.…”

Minimally invasive repair of the mitral valve: Technological and clinical developments

“…Insertion of artificial chordae is an accepted surgical method for repairing the mitral valve when regurgitation is caused by rupture or elongation of the natural chordae (12,13). Several groups have designed a conceptual apparatus to implant new chords on the beating heart without the use of cardiopulmonary bypass.…”