Preprint / Version 1

Chordae Tendineae Repair Techniques: A Literature Review

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  • Dayakshin Arumugam Emerald High School, Dublin, CA

DOI:

https://doi.org/10.58445/rars.2683

Keywords:

Chordae Tendineae, Chordae Tendineae Repair Techniques, cardiac surgery

Abstract

Advancements in cardiac surgery have significantly transformed the management of mitral valve (MV) disease, with chordae tendineae repair techniques emerging as crucial for restoring heart function and preventing heart failure. Among these, the neochord procedure has gained increasing popularity as a primary repair approach. Many studies longitudinally followed patients who received neochord procedures to see their overall, long-term outcomes. In general, these studies found long-term outcomes to be positive, including low rates of disease recurrence and reoperation. Studies continue to demonstrate that the neochord procedure is effective at mitigating MV regurgitation while also improving overall heart function. Complications have been found to be rare for this procedure. These findings position the neochord procedure as a safe, effective, and increasingly preferred surgical option for appropriately selected patients.

While current evidence strongly supports the safety and efficacy of the neochord procedure, future research should focus on large-scale, randomized controlled trials comparing neochord to other minimally invasive and conventional mitral valve repair techniques. Additionally, further studies are needed to evaluate the long-term durability of neochord implants beyond the current follow-up periods, explore patient selection criteria, and optimize procedural techniques to enhance outcomes.

References

Boon, R., Hazekamp, M., Hoohenkerk, G., Rijlaarsdam, M., Schoof, P., Koolbergen, D., Heredia, L., & Dion, R. (2007). Artificial chordae for pediatric mitral and tricuspid valve repair. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 32(1), 143–148. https://doi.org/10.1016/j.ejcts.2007.03.035

Cimen, S., Ketenci, B., Ozay, B., & Demirtas, M. (2006). Neo-chordae length adjustment in mitral valve repair. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 29(5), 843–844. https://doi.org/10.1016/j.ejcts.2006.01.049

Chiappini, B., Sanchez, A., Noirhomme, P., Verhelst, R., Rubay, J., Poncelet, A., Funken, J. C., & El Khoury, G. (2006). Replacement of chordae tendineae with polytetrafluoroethylene (PTFE) sutures in mitral valve repair: early and long-term results. The Journal of heart valve disease, 15(5), 657–663.

Cleveland Clinic. (2015). Mitral Valve Repair | Cleveland Clinic. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/17240-mitral-valve-repair

Colli, A., Besola, L., Montagner, M., Soriani, N., Manzan, E., Bizzotto, E., Zucchetta, F., Azzolina, D., Bellu, R., Sarais, C., Pittarello, D., & Gerosa, G. (2018). Acute intraoperative echocardiographic changes after transapical off-pump mitral valve repair with NeoChord implantation. International journal of cardiology, 257, 230–234. https://doi.org/10.1016/j.ijcard.2018.01.026

David, T. E., David, C. M., Lafreniere-Roula, M., & Manlhiot, C. (2020). Long-term outcomes of chordal replacement with expanded polytetrafluoroethylene sutures to repair mitral leaflet prolapse. The Journal of thoracic and cardiovascular surgery, 160(2), 385–394.e1. https://doi.org/10.1016/j.jtcvs.2019.08.006

Di Micco, L., Biffi, B., Schievano, S., Boso, D. P., Besola, L., Fiocco, A., Gerosa, G., Susin, F. M., Colli, A., & Peruzzo, P. (2022). Beating heart implantation of transventricular artificial cordae: How can access site selection and leaflet insertion improve mitral regurgitation correction?. Medical engineering & physics, 101, 103773. https://doi.org/10.1016/j.medengphy.2022.103773

D'Onofrio, A., Cibin, G., Pittarello, D., & Gerosa, G. (2022). Double Transapical Access During Neochord Implantation. The Annals of thoracic surgery, 113(4), e291–e293. https://doi.org/10.1016/j.athoracsur.2021.05.079

Gerosa, G., D'Onofrio, A., Besola, L., & Colli, A. (2018). Transoesophageal echo-guided mitral valve repair using the Harpoon system. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 53(4), 871–873. https://doi.org/10.1093/ejcts/ezx365

Grinberg, D., Cottinet, P. J., Thivolet, S., Audigier, D., Capsal, J. F., Le, M. Q., & Obadia, J. F. (2019). Measuring chordae tension during transapical neochordae implantation: Toward understanding objective consequences of mitral valve repair. The Journal of thoracic and cardiovascular surgery, 158(3), 746–755. https://doi.org/10.1016/j.jtcvs.2018.10.029

Jeong, S., Kim, S. M., Hong, W., Ko, M., McPherson, D. D., & Kim, H. (2023). Biomechanical Evaluation of Mitral Valve Repair: Virtual Chordal Transposition to Restore Anterior Leaflet Prolapse. Reviews in cardiovascular medicine, 24(12), 367. https://doi.org/10.31083/j.rcm2412367

Lessana, A., Romano, M., Lutfalla, G., Carbone, C., Palsky, E., Amalou, S. A., & Escorsin, M. (1988). Treatment of ruptured or elongated anterior mitral valve chordae by partial transposition of the posterior leaflet: experience with 29 patients. The Annals of thoracic surgery, 45(4), 404–408. https://doi.org/10.1016/s0003-4975(98)90013-3

Li, J., & Duan, Q. J. (2021). Severe hemolytic anemia and acute renal failure after mitral valve repair associated with non-endothelialization of artificial chordae tendinae: case report. Journal of cardiothoracic surgery, 16(1), 303. https://doi.org/10.1186/s13019-021-01686-6

Moore, R. A., Wierup, P., Burns, D. J. P., & Gillinov, A. M. (2020). Early failure after non-resectional mitral valve repair with artificial chordae. Journal of cardiac surgery, 35(9), 2432–2435. https://doi.org/10.1111/jocs.14817

Murashita, T., Hoashi, T., Kagisaki, K., Kurosaki, K., Shiraishi, I., Yagihara, T., & Ichikawa, H. (2012). Long-term results of mitral valve repair for severe mitral regurgitation in infants: fate of artificial chordae. The Annals of thoracic surgery, 94(2), 581–586. https://doi.org/10.1016/j.athoracsur.2012.03.064

Oda, S., Nakano, T., Tatewaki, H., Hinokiyama, K., Machida, D., & Kado, H. (2013). A 17-year experience with mitral valve repair with artificial chordae in infants and children. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 44(1), e40–e45. https://doi.org/10.1093/ejcts/ezt183

Padala, M., Powell, S. N., Croft, L. R., Thourani, V. H., Yoganathan, A. P., & Adams, D. H. (2009). Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: quadrangular resection versus triangular resection versus neochordoplasty. The Journal of thoracic and cardiovascular surgery, 138(2), 309–315. https://doi.org/10.1016/j.jtcvs.2009.01.031

Paulsen, M. J., Imbrie-Moore, A. M., Wang, H., Bae, J. H., Hironaka, C. E., Farry, J. M., Lucian, H. J., Thakore, A. D., MacArthur, J. W., Cutkosky, M. R., & Woo, Y. J. (2020). Mitral chordae tendineae force profile characterization using a posterior ventricular anchoring neochordal repair model for mitral regurgitation in a three-dimensional-printed ex vivo left heart simulator. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 57(3), 535–544. https://doi.org/10.1093/ejcts/ezz258

Ragnarsson, S., Sjögren, J., Stagmo, M., Wierup, P., & Nozohoor, S. (2017). Assessment of Mitral Valve Repair With Exercise Echocardiography: Artificial Chordae vs Leaflet Resection. Seminars in thoracic and cardiovascular surgery, 29(1), 25–32. https://doi.org/10.1053/j.semtcvs.2017.01.001

Saccocci, M., & Colli, A. (2022). Actual perspective on off-pump transapical artificial chord implantation. Journal of cardiac surgery, 37(5), 1250–1253. https://doi.org/10.1111/jocs.16330

Takamatsu, M., Hirotani, T., Ohtsubo, S., & Takeuchi, S. (2018). Tricuspid valve repair: Chordae transposition of the entire posterior leaflet for extensive anterior leaflet prolapse. The Journal of thoracic and cardiovascular surgery, 156(2), 655–657. https://doi.org/10.1016/j.jtcvs.2018.03.102

Wang, S., Meng, X., Hu, S., Sievert, H., Xie, Y., Hu, X., Sun, Y., Luo, Z., Zhou, H., Zhang, G., & Pan, X. (2022). Initial experiences of transapical beating-heart mitral valve repair with a novel artificial chordal implantation device. Journal of cardiac surgery, 37(5), 1242–1249. https://doi.org/10.1111/jocs.16342

Wang, S., Meng, X., Luo, Z., & Pan, X. (2018). Transapical Beating-Heart Mitral Valve Repair Using a Novel Artificial Chordae Implantation System. The Annals of thoracic surgery, 106(5), e265–e267. https://doi.org/10.1016/j.athoracsur.2018.05.031

Zhu, Y., Yajima, S., Park, M. H., Venkatesh, A., Stark, C. J., Tran, N. A., Walsh, S. K., Ethiraj, S., Wilkerson, R. J., Lin, L. E., Lee, S. H., Gates, K. Y., Arthur, J. D., Baker, S. W., Mullis, D. M., Wu, C. A., Harima, S., Pokhrel, B., Resuello, D., Bergamasco, H., … Woo, Y. J. (2024). Large Animal

Translational Validation of 3 Mitral Valve Repair Operations for Mitral Regurgitation Using a Mitral Valve Prolapse Model: A Comprehensive In Vivo Biomechanical Engineering Analysis. Circulation. Cardiovascular interventions, 17(4), e013196. https://doi.org/10.1161/CIRCINTERVENTIONS.123.013196

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2025-06-29

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