Biomechanical characteristics of different methods of neo‐chordal fixation to the papillary muscles

Background and Aim of the Study Several techniques have been described for neo‐chordal fixation to the papillary muscles without any reported clinical differences. The objective of this study is to compare in vitro the biomechanical properties of four of these common techniques. Methods We studied the biomechanical properties of expanded polytetrafluoroethylene neo‐chordal fixation using four techniques: nonknotted simple stitch, nonknotted figure‐of‐eight stitch, knotted pledgeted mattress stitch, and knotted pledgeted stitch using commercially available prefabricated loops. Neo‐chordae were submitted to a total of 20 traction‐relaxation cycles with incremental loads of 1, 2, and 4 N. We calculated the elongation, the force‐strain curve, elasticity, and the maximum tolerated load before neo‐chordal failure. Results The elongation of the neo‐chordae was lowest in the simple stitch followed by the figure‐of‐eight, the pledgeted mattress, and he commercially prefabricated loops (p