Intraoperative view of the implant of the V-Chordal system. A: The V-Chordal device is implanted with a sutureless procedure in the tip of the papillary muscle using the self-fixating helical element, activated by the handle. Note the 4-0 polypropylene stay suture in the middle of the anterior leaflet. B: The 3-0 braided sutures are positioned in the free edge of the anterior leaflet. At this time, the connecting cable is left aside, lying on the posterior commissure while the sutures are implanted on the leaflet. C: Neochordae suture view prior to atrial closure. The connecting cable is still attached to the neochordae implant and is left across the mitral coaptation line and across the atriotomy until beating-heart adjustment is done. D: The left atrium has been closed. The sutures are kept tight with a tourniquet (blue tube) around the connecting cable (transparent tube). Epicardial echo probe is now positioned in the atrioventricular groove to guide adjustment. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of the article.)