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.