Mitral valve reconstruction with artificial chordae: How to secure the desired length?

The use of sutures as artificial chordae is widely established in mitral valve reconstruction. After the correct length of the chordae is determined by saline injection, there is a variety of methods to secure that length before tying surgical knots. We investigated the amount of damage posed by applying a haemoclip or a pean clamp and by using a knot-pusher. No differences in breaking forces were found, if a pean clamp was applied, with or without the use of a knot-pusher. (control group: 36 plusmn 4.4 N; Pean: 37.5 plusmn 4.7 N; control group + knotpusher:38.6 plusmn 5 N; pean + knot-pusher: 37.5 plusmn 4.2 N). Using a haemoclip significantly decreased the breaking forces to 12.9 plusmn 14.6 N compared to control group (p<0.01). The length can be safely secured by applying a pean clamp. Haemoclips should not be used on artificial chordae.