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Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: A 25-year experience
The Journal of Thoracic and Cardiovascular Surgery, 07/05/2012
David TE et al. – Chordal replacement with polytetrafluoroethylene sutures expands the indication of repair to patients with prolapse of multiple segments. Valve function remains stable in most patients during the first 2 decades of follow–up.
Methods- From 1986 to 2004, 606 consecutive patients with degenerative mitral regurgitation had mitral valve repair with chordal replacement with polytetrafluoroethylene sutures.
- Patients' mean age was 57 years, and 73.6% were men.
- Isolated prolapse of the anterior leaflet was present in 17.6% of patients, isolated posterior leaflet prolapse was present in 29.5% of patients, and bileaflet prolapse was present in 52.9% of patients.
- Prolapse was corrected by creating 2 to 38 neochords of polytetrafluoroethylene sutures (mean, 13 ± 9 per patient).
- The mean follow–up was 10.1 years, and 96% of the patients had multiple echocardiographic studies over the years.
- There were 5 early and 106 late deaths.
- Age, diabetes, hypertension, chronic obstructive lung disease, New York Heart Association functional classes III and IV, and ejection fraction less than 40% were independent predictors of mortality.
- At 18 years, freedom from reoperation on the mitral valve was 90.2% ± 2.4%, freedom from recurrent severe mitral regurgitation was 91.0% ± 2.7%, and freedom from moderate or severe mitral regurgitation was 67.5% ± 4.2%.
- Cox regression analysis revealed that isolated prolapse of the anterior leaflet was predictive of reoperation, and that older age, hypertension, and left ventricular ejection fraction less than 40% were predictive of recurrent moderate or severe mitral regurgitation.
