Mitral valve repair with artificial chords: Tips and tricks

Abstract

Mitral valve regurgitation (MR) is a common valvular disorder occurring in up to 10% of the general population. Mitral valve reconstructive strategies may address any of the components, annulus, leaflets, and chords, involved in the valvular competence. The classical repair technique involves the resection of the prolapsing tissue. Chordal replacement was introduced already in the '60, but in the mid '80, some surgeons started to use expanded polytetrafluoroethylene (ePTFE) Gore‐Tex sutures. In the last years, artificial chords have been used also using transcatheter approach such as NeoChord DS 1000 (Neochord) and Harpoon TSD‐5. The first step is to achieve a good exposure of the papillary muscles that before approaching the implant of the artificial chords. Then, the chords are attached to the papillary muscle, with or without the use of supportive pledgets. The techniques to correctly implant artificial chords are many and might vary considerably from one center to another, but they can be summarized into three big families of suturing techniques: single, running or loop. Regardless of how to anchor to the mitral leaflet, the real challenge that many surgeons have taken on, giving rise to some very creative solutions, has been to establish an adequate length of the chords. It can be established based on anatomically healthy chords, but it is important to bear in mind that surgeons work on the mitral valve when the heart is arrested in diastole, so this length could fail to replicate the required length in the full, beating heart. Hence, some surgeons suggested techniques to overcome this problem. Herein, we aimed to describe the current use of artificial chords in real‐world surgery, summarizing all the tips and tricks.

Artificial chordae for anterior leaflet prolapse: Are all the roads leading to Rome?

“…We are waiting for the long term echocardiographic results of the technique described by Nasso et al, 6 that, for its simplicity, can find huge diffusion. Many techniques are described in the literature, 10 all of them supported by good results, as that one described by the Authors. Perhaps it is necessary to be more openminded and to accept the concept that, any technique we use, can work and that mistakes in choosing the correct length can be forgiven if the coaptation length is long.…”

Accuracy in osteotomy drilling using a new universal and disposable drill-stop device for dental implant drills: an in vitro study using a bovine rib model

“…Finally, it has a low coe cient of friction, is impermeable (maintaining its properties in humid environments such as inside the mouth), has a low dielectric constant, is non-stick, and has unusually high thermal stability and mechanical strength (with a high melting point of 300° C) [33]. Because of these properties, PTFE has been widely used in medicine, in the fabrication of vascular and cardiac prostheses [34], auricular [35], nasal [36], and in dentistry as a membrane for bone regeneration [37], for adhesive cementation of dental restorations [38], although its most frequent use is the sealing of screw access holes in implant abutments [39].…”

Minimally Invasive Mitral Valve Repair with Artificial Chordae: Insights from a 6-Year Single-Center Study

“…However, challenges such as the potential for hemolytic anemia, and longevity concerns arising from PTFE hyalinization or calcifcation, are noted [8]. In addition, post-repair remodeling of the left ventricle could lead to mismatched chordae lengths, potentially causing a recurrence of MR [23]. Alongside the artifcial chordae technique (addresses MV leafets), annuloplasty ring usage extends repair durability by restoring the mitral annulus's functional support.…”