Artificial chordae for mitral valve repair: mid-term clinical and echocardiographic results

Objectives: Expanded polytetrafluoroethylene (ePTFE) sutures have been used for replacement of ruptured or elongated chordae tendineae of the mitral valve since 1996 in our unit. This paper reports of the mid-term clinical and echocardiographic results of mitral valve repair with chordal replacement.

Material and Methods: Sixty–seven patients (mean age 60±13 years) underwent mitral valve repair with chordal replacement. Etiology was degenerative in 50, rheumatic in 9, infective in 2 and ischemic in 6. Mean ejection fraction was 58±15 and 88% were in New York Heart Association (NYHA) class III-IV. Eight patients had previous heart operation, and 22 were in atrial fibrillation. In 32 patients, a minimally invasive approach was used. All patients were followed for a mean of 36±21 months. Echocardiographics controls were conducted at one and five years postoperatively.

Results: Anterior leaflet chordae were replaced in 50 patients. There were 3 operative deaths. The echocardiographic controls showed moderate residual mitral regurgitation in 4 and mild in 4 patients. The mean postoperative NYHA class was reduced to 0.2±0.5. Actuarial survival at 5 years was 92.3±3.8%. Two patients required reoperation due to mitral annulus redilatation after suture annuloplasty in the follow-up. Both had competent neochordae found at reoperation. Freedom from reoperation at 5 years was 96.3±2.6% and freedom from nontrivial mitral regurgitation was 84.7±5.4%.

Conclusions: Replacement of chordae tendineae with ePTFE sutures during mitral valve repair has shown good mid-term results. The implantation of the neochordae can be performed safely in minimally invasive procedures