• Noriyuki Kashiyama, Takafumi Masai, Masao Yoshitatsu, Takashi Yamauchi, Yukiko Ogasawara, Yuriko Matsunaga, and Yoshiki Sawa.
• Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
• Interact Cardiovasc Thorac Surg. 2014 Jun 1;18(6):701-5.

ObjectivesThe most difficult aspect of chordal replacement during mitral valve repair is to determine the correct length of the new chordae. A simple technique of chordal replacement was developed employing the new mitral leaflet retractor that enables easy adjustment of the length of artificial chordae.MethodsFor prolapse of the anterior mitral leaflet (AML), the level of the normal opposing posterior leaflet can be used to determine the length of new chordae. We developed a double-headed leaflet retractor with which both mitral leaflets can be retracted simultaneously at the same level. This retractor makes it easy to tie the slippery Gore-Tex sutures for artificial chordae adjusting the length of the new chordae on AML to the level of the opposing normal posterior leaflet. We employed this retractor for the creation of artificial chordae in 55 consecutive patients with degenerative AML prolapse between 2005 and 2013. A ring annuloplasty was concomitantly performed to stabilize the reconstruction.ResultsWe had no hospital death. Follow-up was 100% complete with a mean follow-up duration of 1181 ± 839 (range 50-2892) days. Reoperation-free survival at 5 years was 98.2%. Freedom from moderate-to-severe mitral regurgitation was 88.0% at 5 years. At follow-up, all non-reoperated survivors were in New York Heart Association Class I or II.ConclusionsWe have reported the chordal replacement using the new double-headed mitral leaflet retractor. Our leaflet retractor is a convenient tool representing an easy creation of artificial chordae in mitral valve repair.© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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