DRAWBACKS OF ARTIFICIAL CHORDS
MV repair is expected to last up to 20
years12,13,25,41. Nevertheless, there are some
drawbacks that surgeons need to know when planning to perform a MV
repair.42 There are mainly three reasons for which a
MV repair could fail, which are technical failures, progression of the
disease or new disease (for example endocarditis).43This paragraph is focused on technical failures that a surgeon could
encounter when utilizing artificial chords.
The symptomatology of patients facing failure of artificial chords
varies. In the literature there are some reports regarding the presence
of hemolytic anemia as presentation of mitral valve repair failure,
which might be due to the lack of endothelization of the artificial
chords44.
First of all, artificial chords might break over
time45-47, possibly because of hyalinization of pores
of ePTFE or calcification, even if it is not fully demonstrated, because
of the paucity of scientific data. Therefore, surgeons should avoid
pinching ePTFE with forceps and clamps at the time of surgery.
Risk of MV repair failure is higher in case of chordal rupture and it is
particularly higher when thinner suture (CV5) are
used48, in line with the previously described
biomechanical studies.
Another hot topic regarding the failure of artificial chords is the
effect of the remodeling of the left ventricle. It is possible that the
positive remodeling of the left ventricle after correction of the mitral
regurgitation might cause a mismatch between the artificial chords and
the native ones49. Therefore, when facing patients
with extremely dilated left ventricles, surgeons should measure the
artificial chords bearing in mind that the left ventricle volumes might
reduce over time50.