Mitral Valve Repair Techniques With Neochords: When Sizing Matters

Mitral valve (MV) repair procedures have evolved over time and multiple approaches have been proposed also for the repair with neochords implantation. This article compiles the currently available approaches for implanting and sizing neochords, to restore a proper coaptation of the MV leaflets and a good systo-dyastolic movement. The described techniques are aimed at standardizing chordal measurement, in order to reduce variability in chordal length. The placement of annuloplasty ring before chordae implantation should be avoided. Regardless of the technique chosen, it is important that the implanted chordae do not interfere with normal native chordae, to avoid the risk that neochordae may heal together or get damaged. This article aims to give an overview of the most common sizing techniques available.