Chordal cutting technique through aortotomy to treat chronic ischemic mitral regurgitation: Surgical technique

ObjectiveTo describe original surgical treatment in patients with ischemic mitral valve regurgitation due to tenting phenomenon.BackgroundThe optimal surgical treatment of ischemic mitral regurgitation (MR) in patients with coronary artery disease is controversial. The standard treatment is revascularization and reduction annuloplasty. We describe the first clinical application of an original technique to treat MR, through aortotomy. The chordal cutting technique was described first in experimental studies by Messas et al.MethodsThe procedure consisted in cutting the 2 strut chordae of the anterior mitral valve through a small aortotomy, using a brief conventional cardiopulmonary bypass. All the cases were controlled at the end of the procedure by transesophageal echocardiography (TEE).ResultsFive patients were treated using this technique; the procedure was brief, effective and safe in all the patients. TEE showed no mitral regurgitation. No preoperative morbidity or mortality occurred and post-operative course was uneventful.ConclusionChordal cutting technique through aortotomy is a safe and effective technique that should be considered to treat severe ischemic mitral regurgitation due to tenting phenomenon.