Mitral Valve Repair with Artificial Chords: Tips & Tricks
Michele Di Mauro, MD, PhD, MSC, FESC (1)§, Giorgia
Bonalumi§, MD (2,3), Ilaria Giambuzzi, MD (2,3),Pietro
Messi, MD (3,4), Marco Cargoni, MD (5), Domenico Paparella, MD, (6,7)
Roberto Lorusso*, MD, PhD (1) Antonio M Calafiore* (8), MD
- Cardio-Thoracic Surgery Dept. Heart & Vascular Centre. Maastricht
University Medical Centre (MUMC). Cardiovascular Research Institute
Maastricht (CARIM). Maastricht. The Netherlands.
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan,
Italy
- DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of
Milan, Milan, Italy
- Department of Cardiac Surgery, Istituto Clinico Sant’Ambrogio, Milan,
Italy
- Department of Cardiac Anesthesia, Mazzini Hospital, Teramo, Italy
- Division of Cardiac Surgery, Department of Medical and Surgical
Sciences, University of Foggia, Foggia, Italy.
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care &
Research, Bari, Italy.
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso,
Italy
§some contribution
*co-senior authors
Funding: none
Word count
Address for correspondence
Michele Di Mauro, MD, PhD, MSC, FESC.
Cardio-Thoracic Surgery Dept. Heart & Vascular Centre.
Maastricht University Medical Centre (MUMC).
Cardiovascular Research Institute Maastricht (CARIM).
P. Debyelaan 25, 6202 AZ
Maastricht, The Netherlands
Email:mdimauro1973@gmail.com
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
exploited because of transcatheter techniques such as NeoChord DS 1000
(Neochord, USA) 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 basing 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.