After passing the suture through the free edge of the leaflet and into the papillary muscle, the artificial chord is tied according to the Dubai technique (Dubai stitch). By sliding the knot, the leght of the loop is adjusted and the right coaptation is reached. The length of the loop is then secured and the knot is pushed towards the papillary muscle. Another water test confirms the good continence of the repaired valve, and a mitral ring sizer is used to determine the size of the annuloplasty ring which is then implanted. The left atrial incision is then closed with 2 continuous sutures.
Artificial chord implantation - Dubai stitch and anular ring implantation