INTRODUCTION
Mitral regurgitation (MR) is a common valvular disorder occurring in up
to 10% of the general population.1 It is also the
second most frequent indication for valve heart surgery in
Europe.2
There are two pathways of MR, primary and secondary, and the indications
for treatment vary accordingly.
In case of primitive MR, surgical treatment should be, whenever
possible, the conservative one2, as it is associated
to better outcomes than surgical replacement3.
Mitral valve (MV) reconstructive strategies may address any of the
components involved in the valvular competence such as the annulus, the
leaflets and chords. The classical repair technique encompasses the
resection of the prolapsing tissue, the “French
Correction”4 . Chordal replacement was introduced
already in the ’60, when surgeons used silk and
nylon5,6. Frater and colleagues7used glutaraldehyde fixed bovine pericardium to replace chords tendineae
in a small number of patients with MR. Finally, in the mid ’80, some
surgeons started to use expanded polytetrafluoroethylene (ePTFE)
Gore-Tex sutures8,9
In the last years, the concept of “respect rather than resect” has
caught on, so the implantation of artificial chords to anchor the
leaflets to the papillary muscles has been more widely
used.10,11 Alongside this concept, also the
publication of satisfactory long-term results with 20-year freedom from
re-operation ranging from 74% to 92%12,13,
contributed to the spread of this surgical approach. Moreover, in the
last years, artificial chords have been exploited because of
transcatheter techniques such as NeoChord DS 1000 (Neochord, USA) and
Harpoon TSD-5 (Edwards Lifescience, USA), ChordArt (CoreMedic,
Germany)14,15.
Herein, we aimed to describe the current use of artificial chords in
real world surgery, summarizing all the tips and tricks.