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. 2025 Sep 9:12:1642204.
doi: 10.3389/fcvm.2025.1642204. eCollection 2025.

Five-year comparative outcomes of the track technique versus conventional artificial chordae sizing in anterior mitral leaflet repair

Giuseppe Nasso #  1 , Walter Vignaroli #  2 , Raffaele Bonifazi  1 , Giovanni Valenti  3 , Flavio Fiore  1 , Dritan Hila  1 , Tommaso Loizzo  1 , Rosalba Franchino  1 , Antongiulio Valenzano  1 , Giacomo Errico  1 , Vincenza Vitobello  1 , Giuseppe Balducci  1 , Giacomo Schinco  1 , Felice Agrò  4 , Mario Siro Brigiani  1 , Cataldo Girasoli  1 , Guido Lembo  1 , Ernesto Greco  5 , Gaetano Contegiacomo  1 , Giuseppe Santarpino  6   7   8 , Giuseppe Speziale  1
Affiliations

Five-year comparative outcomes of the track technique versus conventional artificial chordae sizing in anterior mitral leaflet repair

Giuseppe Nasso et al. Front Cardiovasc Med. .

Abstract

Introduction: Determining artificial chordae length is crucial for successful mitral valve repair (MVr). This study evaluates five-year outcomes of a novel "track technique", which uses an annular guiding device for chordal length adjustment, compared to a conventional approach.

Methods: A retrospective analysis was conducted on 47 patients who underwent MVr with artificial chordae: 25 received the track technique, and 22 underwent conventional chordal sizing. All patients received complete annuloplasty and were followed for five years. The primary endpoint was freedom from moderate or severe mitral regurgitation (MR); secondary endpoints included NYHA class, coaptation length, freedom from reintervention, and all-cause mortality.

Results: At five years, neither group showed moderate/severe MR or required reoperation. However, the track group showed superior outcomes: significantly longer coaptation length (10.7 ± 1.5 mm vs. 8.6 ± 1.8 mm, p = 0.03) and lower residual MR (12% vs. 32%, p = 0.04). More than 90% of patients in both groups were in NYHA class I-II.

Discussion: In conclusion, the track technique is a safe, effective, and reproducible method for artificial chordae sizing in MVr. It ensures better leaflet coaptation, reduces residual MR, and maintains favorable clinical results over a five-year period.

Keywords: anterior leaflet prolapse; artificial chordae; mitral regurgitation; mitral repair; mitral valve surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor OD declared a past co-authorship with the author GS.

Figures

Figure 1
Figure 1
Anatomical illustration of mitral valve repair using track technique.
Figure 2
Figure 2
Comparison of coaptation length at 5-year follow-up between the track technique and the conventional approach.
See this image and copyright information in PMC

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