Purpose of review
In this review, we summarize the history of mitral valve
repair, discuss the broad principles of neochord preparation and implantation, and highlight comparative outcomes between mitral valve
repair strategies while focusing on the risk of neochordal rupture.
There have been several recent studies comparing outcomes been leaflet-resection and nonresection, neochord-based mitral valve
repair. Operative mortality was very low regardless of repair strategy; however, the rate of mitral valve
reoperation is lower in those that undergo a neochord-based repair with overall lower mean mitral gradients postrepair. The introduction of minimally invasive approaches to mitral valve
repair has preferentially favored an increase in neochord-based repair, given the technical simplicity compared with resection-based approaches. In very rare cases, neochord rupture can occur, likely secondary to a combination of chordal calcification and mechanical stress.
The method of performing mitral valve
repair with neochord implantation has demonstrated superior durability over leaflet resection
approaches with equivalent operative outcomes. Although the risk of neochord rupture exists, it is exceedingly rare, and should not be considered a limitation to a neochord-based mitral valve
repair. Recurrent mitral regurgitation secondary to neochord rupture is incredibly rare; however, regular echocardiographic evaluation of these patients appears warranted, especially when follow-up extends over 10 years.