| DISCUSSION
When compared to mitral valve replacement, mitral valve repair in patients with degenerative disease is associated with superior outcomes and, in addition, excellent durability13. However, there is an inherent failure rate after mitral valve repair14-15. Failure within 1 year of repair is traditionally attributed to technical error rather than to disease progression or new pathology 16. Non-resectional techniques including the use of artificial chordae have potential advantages over leaflet resection stemming primarily from preservation of mitral valve physiology 17. Here we describe our experience with 2 patients who required early reoperation for recurrent mitral regurgitation after mitral valve repair using artificial chordae.
In patients with left ventricular dysfunction and enlargement, mitral valve repair can be associated with reverse remodeling that includes a reduction in left ventricular dimension. We suggest here that reverse remodeling after mitral valve repair may occasionally result in ventricular morphology that causes recurrent prolapse in patients whose initial mitral valve repair was achieved with the application of artificial chordae. Further study of a larger number of patients will be necessary to understand the precise changes in ventricular dimension that can cause recurrent prolapse when artificial chordae are employed.
Determination of proper chordal length during surgery remains crucial in successfully performing artificial chord repair. Numerous techniques have been described to expand the number of tools at the surgeon’s disposal 18. We routinely utilize artificial chords using either the free-hand or pre-measured loop techniques with great success19. We suggest the mechanism of early failure described here represents an inherent risk of correcting mitral regurgitation in patients who have left ventricular dilatation and dysfunction rather than a technical failure. Reverse ventricular remodeling may result in recurrent prolapse in such patients. One option is to create chords that are somewhat shorter in patients with ventricular dilatation, anticipating the possibility of remodeling. A second option is to employ resectional techniques in such patients.