Five-Year Comparative Outcomes of the Track Technique Versus Conventional Artificial Chordae Sizing in Anterior Mitral Leaflet Repair

Giuseppe Nasso^1*Walter Vignaroli¹Raffaele Bonifazi¹Giovanni Valenti²Flavio Fiore¹Dritan Hila¹Tommaso Loizzo¹Rosalba Franchino¹Antongiulio Valenzano¹Giacomo Errico¹Vincenza Vitobello¹Giuseppe Balducci¹Giacomo Schinco¹Felice Agrò³Mario Siro Brigiani¹Cataldo Girasoli¹Guido Lembo¹Ernesto Greco⁴Gaetano Contegiacomo¹Giuseppe Santarpino¹Giuseppe Speziale¹

• ¹Gruppo Villa Maria SpA, Lugo, Italy
• ²Ospedale Lorenzo Bonomo, Andria, Italy
• ³Universita Campus Bio-Medico di Roma, Rome, Italy
• ⁴Universita Europea di Roma, Rome, Italy

Determining artificial chordae length is crucial for successful mitral valve repair (MVr). This study evaluates five-year outcomes of a novel "track technique," which uses an annular guiding device for chordal length adjustment, compared to a conventional approach. A retrospective analysis was conducted on 47 patients who underwent MVr with artificial chordae: 25 received the track technique, and 22 underwent conventional chordal sizing. All patients received complete annuloplasty and were followed for five years. The primary endpoint was freedom from moderate or severe mitral regurgitation (MR); secondary endpoints included NYHA class, coaptation length, freedom from reintervention, and allcause mortality. At five years, neither group showed moderate/severe MR or required reoperation. However, the track group showed superior outcomes: significantly longer coaptation length (10.7 ± 1.5 mm vs. 8.6 ± 1.8 mm, p = 0.03) and lower residual MR (12% vs. 32%, p = 0.04). More than 90% of patients in both groups were in NYHA class I-II. In conclusion, the track technique is a safe, effective, and reproducible method for artificial chordae sizing in MVr. It ensures better leaflet coaptation, reduces residual MR, and maintains favorable clinical results over a five-year period.