Artificial chordal replacement for complex mitral valve repair

  • J.S. Rankin
  • D.D. Alfery
  • R. Orozco
  • R.S. Binford
  • C.A. Burrichter
  • L.A. BrunstingIII


The development of mitral valve repair is one of the all-time success stories in medicine. In the 1960s and 1970s, mitral valve replacement was the highest risk adult cardiac procedure in most centers, with operative mortalities approaching 20–30% in many categories. Based on innovation from many sources, reparative methods were refined and developed, and Carpentier’s lecture before the American Association for Thoracic Surgery in 1983 brought together the techniques of ring annuloplasty, leaflet reconstruction, and chordal shortening/ transfer into a unified approach. Carpentier’s contributions stimulated great interest in repair, and progress continued on many fronts.


Mitral Valve Papillary Muscle Mitral Valve Repair Mitral Valve Surgery Severe Mitral Regurgitation 
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  1. 1.
    Kouchoukos NT (1973) Problems in mitral valve replacement. In: Kirklin TW (ed) Advances in cardiovascular surgery. Grune & Stratton, New York, pp. 205–216Google Scholar
  2. 2.
    Rankin JS (1986) Mitral and tricuspid valve disease: historical aspects. In: Sabiston DC, Jr. (ed) Textbook of surgery. WB Saunders Company, Philadelphia, p 2345Google Scholar
  3. 3.
    Carpentier A (1983) Cardiac valve surgery - the »French correction«. J Thorac Cardiovasc Surg 86:323–337PubMedGoogle Scholar
  4. 4.
    Vetter HO, Burack JH, Factor SM, et al. (1986) Replacement of chordae tendineae of the mitral valve using the new expanded PTFE suture in sheep. In: Bodnar E, Yacoub M (eds) Biologic bioprosthetic valves. Yorke Medical Books, New York, pp 772–784Google Scholar
  5. 5.
    Frater RWM, Vetter HO, Zussa C, et al. (1990) Chordal replacement in mitral valve repair. Circulation 82 (suppl IV):125–130Google Scholar
  6. 6.
    Frater RWM, Gabbay S, Shore D, et al. (1983) Reproducible replacement of elongated or ruptured mitral valve chordae. Ann Thorac Surg 35:1428–1436CrossRefGoogle Scholar
  7. 7.
    Frater RMW (1964) Anatomical rules for the plastic repair of a diseased mitral valve. Thorax 19:458–464PubMedCrossRefGoogle Scholar
  8. 8.
    Frater RWM (1962) Artificial heart valves. The Lancet 280:1171CrossRefGoogle Scholar
  9. 9.
    Rankin JS, Orozco RE, Addai TR, et al. (2004) Several new considerations in mitral valve repair. J Heart Valve Dis 13:399–409PubMedGoogle Scholar
  10. 10.
    Rankin JS, Orozco RE, Rodgers TL, et al. (2006) »Adjustable« artificial chordal replacement for repair of mitral valve prolapse. Ann Thorac Surg 81:1526–1528PubMedCrossRefGoogle Scholar
  11. 11.
    Glower DD, Tuttle RH, Bashore TM, Harrison JK, Wang A, Gehrig T, Rankin JS (2009) Pure annular dilatation as a cause of mitral regurgitation: a clinically distinct entity of female heart disease. J Heart Valve Dis 18:284–288PubMedGoogle Scholar
  12. 12.
    Brunsting LA, Orozco RE, Rankin JS, Binford RS (2009) Robotic artificial chordal replacement for repair of mitral valve prolapse. Innovations 4:229–232Google Scholar
  13. 13.
    Rankin JS, Alfery DD, Orozco RE, et al. (2008) Techniques of artificial chordal replacement for mitral valve repair: use in multiple pathologies. Op Tech Thorac Cardiovasc Surg 13:74–82CrossRefGoogle Scholar
  14. 14.
    Gaca JG, Sheng S, Rankin JS, et al. (2010) Outcomes for endocarditis surgery in North America: a simplified risk scoring system and need for clinical innovationJ Thorac Cardiovasc Surg (in press)Google Scholar
  15. 15.
    Shang E, Forrest GN, Chizmar T, et al. (2009) Mitral valve infective endocarditis: Benefit of early operation and aggressive use of repair. Ann Thorac Surg 87:1728–1734PubMedCrossRefGoogle Scholar
  16. 16.
    Chauvaud S, Jebara V, Chachques JC, et al. (1991) Valve extension with glutaraldehyde-preserved autologous pericardium. Results in mitral valve repair. J Thorac Cardiovasc Surg 102:171–177PubMedGoogle Scholar
  17. 17.
    Ng CK, Nesser J, Punzengruber C, et al. (2001) Valvuloplasty with glutaraldehyde-treated autologous pericardium in patients with complex mitral valve pathology. Ann Thorac Surg 71:78–85PubMedCrossRefGoogle Scholar
  18. 18.
    Rankin JS, Sharma MK, Teague SM, et al. (2008) A new method of mitral valve repair for rheumatic disease: Preliminary study. J Heart Valve Dis 17:614–619PubMedGoogle Scholar
  19. 19.
    Rankin JS, Orozco RE, McRae AT (2009) Mitral valve repair for rheumatic disease. Surgical video presented at the Southern Thoracic Surgical Association meeting, November, 2009, to be published at Video downloadable from:
  20. 20.
    Rankin JS, Binford RS, Johnston TS, Matthews JT, Alfery DD, McRae AT, Brunsting LA III (2008) A new mitral valve repair strategy for hypertrophic obstructive cardiomyopathy. J Heart Valve Dis17:642–647PubMedGoogle Scholar
  21. 21.
    Rankin JS (2010) Mitral valve repair for HOCM with severe mitral anomalies. Presented at the STS meeting and published at
  22. 22.
    Glower DD, Tuttle RH, Shaw LK, Orozco RE, Rankin JS (2005) Patient survival characteristics after routine mitral valve repair for ischemic mitral regurgitation. J Thorac Cardiovasc Surg 129:860–868PubMedCrossRefGoogle Scholar
  23. 23.
    Milano CA, Danishmand MA, Rankin JS, et al. (2008) Survival prognosis and surgical management of ischemic mitral regurgitation. Ann Thorac Surg 86:735–744PubMedCrossRefGoogle Scholar
  24. 24.
    Burch G, DePasquale N, Phillips J (1968) The syndrome of papillary muscle dysfunction. Am Heart J 75:399– 412PubMedCrossRefGoogle Scholar
  25. 25.
    Langer F, Rodriguez F, Cheng A, et al. (2006) Posterior mitral leaflet extension: an adjunctive repair option for ischemic mitral regurgitation? J Thorac Cardiovasc Surg 131:868–877PubMedCrossRefGoogle Scholar
  26. 26.
    Gammie JS, Sheng S, Griffith BP, Peterson ED, Rankin JS, O’Brien SM, Brown JM (2009) Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons adult cardiac database. Ann Thorac Surg 87:1431–1439PubMedCrossRefGoogle Scholar
  27. 27.
    Rankin JS, Burrichter CA, Walton-Shirley MK, et al. (2009) Trends in mitral valve surgery: a single practice experience. J Heart Valve Dis 18:359–366PubMedGoogle Scholar
  28. 28.
    Rankin JS, Livesey SA, Smith LR, et al. (1989) Trends in the surgical treatment of ischemic mitral regurgitation: effects of mitral valve repair on hospital mortality. Semin Thorac Cardiovasc Surg 1:149–163PubMedGoogle Scholar
  29. 29.
    Rankin JS, Feneley MP, Hickey MSJ, et al. (1988) A clinical comparison of mitral valve repair versus valve replacement in ischemic mitral regurgitation. J Thorac Cardiovasc Surg 95:165–177PubMedGoogle Scholar
  30. 30.
    Daneshmand MA, Milano CA, Rankin JS, et al. (2010) Influence of patient age on procedural selection in mitral valve surgery. Ann Thorac Surg 90:1479–1486PubMedCrossRefGoogle Scholar
  31. 31.
    Daneshmand MA, Milano CA, Rankin JS, et al. (2009) The surgical treatment of mitral valve prolapse: a 20-year perspective. Ann Thorac Surg 88:1828–1837PubMedCrossRefGoogle Scholar
  32. 32.
    Daneshmand MA, Gaca JC, Rankin JS, Milano CA, Glower DD, Wolfe WG, Smith PK. Effects of valve repair on long-term patient outcomes after mitral valve surgery. In: Hetzer, Rankin,Yankah (eds) Mitral Valve Repair. Springer Verlag, Berlin, pp 195–209Google Scholar
  33. 33.
    Salvador L, Mirone S, Bianchini R, et al. (2008) Twenty-year experience of mitral valve repair with artificial chordae in 608 Patients. J Thorac Cardiovasc Surg 135:1280–1287PubMedCrossRefGoogle Scholar
  34. 34.
    Chiappini B, Sanchez A, Noirhomme P, et al. (2006) Replacement of chordae tendineae with polytetrafluoroethylene (PTFE) sutures in mitral valve repair: early and long-term results. J Heart Valve Dis 15:657–663PubMedGoogle Scholar
  35. 35.
    Lawrie GM, Earle EA, Earle NR. (2006) Feasibility and intermediate term outcome of repair of prolapsing anterior mitral leaflets with artificial chordal replacement in 152 patients. Ann Thorac Surg 81:849–856PubMedCrossRefGoogle Scholar
  36. 36.
    von Oppell UO, Mohr FW (2000) Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops. Ann Thorac Surg 70:2166–2168CrossRefGoogle Scholar
  37. 37.
    David TE, Omran A, Armstrong S, et al. (1998) Long-term results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg 115:1279–1285PubMedCrossRefGoogle Scholar
  38. 38.
    Nigro JJ, Schwartz DS, Bart RD, et al. (2004) Neochordal repair of the posterior mitral leaflet. J Thorac Cardiovasc Surg 127:440–447PubMedCrossRefGoogle Scholar
  39. 39.
    Duebener LF, Wendler O, Nikoloudakis N, et al.(2000) Mitral-valve repair without annuloplasty rings: results after repair of anterior leaflet versus posterior-leaflet defects using ePTFE sutures for chordal replacement. Eur J Cardiothorac Surg 17:206–212PubMedCrossRefGoogle Scholar
  40. 40.
    Tesler UF, Cerin G, Novelli E, Popa A, Diena M (2009) Evolution of surgical techniques for mitral valve repair. Tex Heart Inst J 36:438–440PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • J.S. Rankin
    • 1
  • D.D. Alfery
  • R. Orozco
  • R.S. Binford
    • 2
  • C.A. Burrichter
    • 2
  • L.A. BrunstingIII
    • 2
  1. 1.Department of Cardiac SurgeryVanderbilt University Medical CenterNashvilleUSA
  2. 2.Centennial Medical CenterNashvilleUSA

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