The patient was suffering from hemolysis and mitral regurgitation. A hemisternotomy was performed after femoral vein cannulation. A new cross-clamp was used and is shown in the video. Cardioplegia was given, and the left atrial appendage was removed. The aorta was retracted so that the roof of the left atrium was visible and then opened with a rooftop incision.  

The previous mitral ring was removed along with its Cor-Knots, and the torn previous chords were observed. These chords did not have a large enough posterior leaflet to prevent excess tension on them, which was the reason for their failure. Sutures were placed, and a chordal-sparing 33 mm biological mitral valve replacement was performed, leaving the posterior leaflet in place.  

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