Long-Term Outcomes of Mitral Valve Repair Using Artificial Chordae Versus Techniques Without Artificial Chordae (Resection and Non - Resection): A Systematic Review

Introduction. Degenerative mitral regurgitation from leaflet prolapse represents a leading indication for mitral valve surgery. While repair remains preferred over replacement, the optimal technique, leaflet resection versus artificial chordae implantation, continues to be debated. Aim. To compare long-term results of mitral valve repair with and without Gore-Tex artificial chordae, using both resectional and non-resectional approaches, such as the edge-to-edge (Alfieri) technique. Materials and Methods. We conducted a systematic literature search across PubMed, Scopus, and the Cochrane Library for studies published between January 2015 and October 2025. Data were extracted on study characteristics, patient demographics, surgical techniques, and outcomes. Results. Six studies (n=2.980) were analyzed. Both techniques showed excellent 10–15-year freedom from reoperation (93-97.7 %; p>0.05). Artificial chordae had less residual mitral regurgitation (MR ≥2+) at predischarge, but 10-year recurrence rates were comparable (23.9 % vs 20.8 %; p=0.834). Hemodynamics and early mortality (0.7 % vs 1.6 %; p=0.09) were similar. Notably, artificial chordae complications included late suture rupture, varying by type (CV-5: 1.8 % vs CV-4: 0.2 %). Discussion. This review shows that mitral valve repair using artificial chordae yields long-term outcomes comparable to those of resection and non-resection techniques. Repair durability and valve hemodynamics are similar across approaches, while artificial chordae may better preserve left ventricular function in selected patients. Conclusion. Long-term outcomes after mitral valve repair are excellent regardless of whether artificial chordae or resection-based techniques are used. Non-resectional repair with the Alfieri technique is a durable alternative in appropriately selected cases of bileaflet prolapse.