• Michael Ibrahim, Christopher Rao, Maria Savvopoulou, Roberto Casula, and Thanos Athanasiou.
• Harefield Heart Science Centre, National Heart and Lung Institute, Imperial College London, Harefield Hospital, Harefield, Middlesex, UK.
• Eur J Cardiothorac Surg. 2014 Apr 1; 45 (4): 593-601.

ObjectivesThe use of artificial chordae techniques has increased the number of mitral valve lesions which are amenable to repair. Artificial chordae can be adapted for a wide range of mitral valve pathologies including restricting the motion of overly mobile 'floppy' Barlow disease leaflets, replacing diseased chordae and improving coaptation in degenerative disease. There is continuing concern about the long-term performance of artificial chordae, which become endothelialized over time and may exhibit complications during the early or late follow-up period.MethodsTo address these issues, we reviewed the literature and extracted 17 papers reporting outcomes following artificial chordae replacement. We discuss the evidence of the effect of artificial chordae on mortality, morbidity and valve performance as measured by echocardiography and complications related to the chordae. We discuss in detail studies comparing artificial chordae with more widely used quadrangular resection techniques.ResultsIn general, outcomes with respect to mortality, morbidity, rates of reoperation, long-term function and complications of artificial chordae implantation are excellent in a range of pathological settings and in both children and adults. These results are comparable with classical Carpentier techniques and there is some evidence that chordal replacement techniques can in some respects improve the risk-benefit ratio for outcomes compared with the classical Carpentier techniques.ConclusionsA number of problems remain in the use of artificial chordae, especially the proper determination of their length. Techniques that solve these issues may enhance patient outcomes further.

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