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.

Figure 1A:

Techniques for the repair of the anterior mitral leaflet. The figure panel shows the essential steps of the techniques detailed in Table 1 for the repair of the anterior mitral leaflet. Original figures adapted from the relevant publications.

Figure 1B:

Techniques for the repair of the anterior mitral leaflet. The figure panel shows the essential steps of further techniques detailed in Table 1 for the repair of the anterior mitral leaflet. Original figures adapted from the relevant publications.

Figure 2:

Techniques for the repair of the posterior or both mitral leaflets. The figure panel shows the essential steps of the techniques detailed in Table 2 for the repair of the posterior (or both) mitral leaflet(s). Original figures adapted from the relevant publications.