CUTTING THE SECOND ORDER CHORDS DURING MITRAL VALVE REPAIR
- Antonio Calafiore,
- Sotirios Prapas,
- Antonio Totaro,
- Stefano Guarracini,
- Marco Cargoni,
- Kostas katsavrias,
- Khalil Fattouch,
- Michele Di Mauro
Antonio Calafiore
Department of Cardiovascular Diseases Gemelli Molise Campobasso Italy
Corresponding Author:am.calafiore@gmail.com
Author ProfileSotirios Prapas
Errikos Ntynan Hospital Center Pathologiko
Author ProfileAntonio Totaro
Department of Cardiovascular Diseases Gemelli Molise Campobasso Italy
Author ProfileStefano Guarracini
Department of Cardiology “Pierangeli” Hospital Pescara Italy
Author ProfileKostas katsavrias
Errikos Ntynan Hospital Center Pathologiko
Author ProfileKhalil Fattouch
Universita degli Studi di Palermo Dipartimento di Discipline Chirurgiche Oncologiche e Stomatologiche
Author ProfileMichele Di Mauro
Universiteit Maastricht Cardiovascular Research Institute Maastricht
Author ProfileAbstract
The chordae tendinae connect the papillary muscles to the mitral valve.
While the first-order chordae serve to secure the leaflets to maintain
valve closure and prevent mitral valve prolapse, the second-order
chordae are believed that they play a role in maintaining normal LV size
and geometry. The papillary muscles, from where the chordae tendinae
originate, function as shock absorbers that compensate for the geometric
changes of the left ventricular wall. The second-order chordae connect
the PMs to both trigons under tension. The tension distributed towards
the second-order chordae has been demonstrate to be more than three-fold
that in the first-order counterpart. Cutting the second-order chordae
puts all the tension on the first-order chordae, that can go closer to
their rupture point. However, it has been experimentally demonstrated
that the tension where the first-order chordae break is 6.8 N, by far
higher than the maximal tension reached, that is 0.4 N. Even if the
clinical reports have been favorable, the importance of cutting the
second-order chordae to recover curvature of the anterior leaflet and
increasing the coaptation length between the mitral leaflet has been
slowly absorbed by the surgical world. Nevertheless, there are
progressive demonstrations that chordal tethering affects the anterior
leaflet not only in secondary, but also in primary mitral regurgitation,
having a not negligeable role in the long-term outcome of mitral repair.Dec 2022Published in Journal of Cardiac Surgery volume 37 issue 12 on pages 4072-4078. 10.1111/jocs.17194