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.