Thorac Cardiovasc Surg 2007; 55(4): 239-244
DOI: 10.1055/s-2006-955947
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Artificial Chordae for Mitral Valve Repair: Mid-Term Clinical and Echocardiographic Results

P. S. Risteski1 , T. Aybek1 , O. Dzemali1 , M. Doss1 , M. Scherer1 , S. Dogan1 , A. Moritz1
  • 1Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
Further Information

Publication History

received October 31, 2006

Publication Date:
04 June 2007 (online)

Abstract

Background: This paper reports on the mid-term clinical and echocardiographic results of mitral valve repair with chordal replacement. Methods: Sixty-nine patients (mean age 61 ± 14 years) underwent mitral valve repair with chordal replacement. The etiology was degenerative in 53 (77 %), rheumatic in 7 (10 %), ischemic in 6 (9 %) and infective in 3 (4 %). Mean ejection fraction was 58 ± 14. In 35 patients (51 %), a minimally invasive approach was used. Mean follow-up time was 45 ± 27 months. Results: Anterior leaflet chordae were replaced in 58 (84 %) patients. There were 3 operative deaths. Freedom from non-trivial recurrent mitral regurgitation (MR) was 81.3 ± 8.7 % at 97 months. Follow-up echocardiographic controls showed mild recurrent MR in 5 (8 %) patients and moderate in 2 (3.2 %). These two patients required reoperation due to mitral annulus redilation after suture annuloplasty. Competent neochordae were found at reoperation. Freedom from reoperation at 97 months was 96.6 ± 2.4 %. Four patients died during follow-up resulting in an actuarial survival of 87 ± 6.2 %. Conclusion: The replacement of chordae tendineae with ePTFE sutures during mitral valve repair has shown good mid-term results. The implantation of the neochordae can be also performed safely using minimally invasive procedures.

References

  • 1 Braunberger E, Deloche A, Berrebi A. et al . Very long-term results (more than 20 years) of valve repair with Carpentier's techniques in nonrheumatic mitral valve insufficiency.  Circul. 2001;  104 (Suppl 1) I8-I11
  • 2 Cohn L, Couper G, Aranki S. et al . Long-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve.  J Thorac Cardiovasc Surg. 1994;  107 142-151
  • 3 David T E. Replacement of chordae tendineae with expanded polytetrafluoroethylene.  J Card Surg. 1989;  4 286-290
  • 4 Salisbury P F, Cross C E, Reiben P A. Chorda tendinea tension.  Am J Physiol. 1963;  205 385-392
  • 5 Nigro J J, Schwartz D S, Bart R D. et al . Neochordal repair of the posterior mitral leaflet.  J Thorac Cardiovasc Surg. 2004;  127 440-447
  • 6 Zussa C, Poleser E, Rocco F, Valfre C. Artificial chordae in the treatment of anterior mitral leaflet pathology.  Cardiovasc Surg. 1997;  5 125-128
  • 7 Murakami T, Yagihara T, Yamamoto F, Uemura H, Yamashita K, Ishizaka T. Artificial chordae for mitral valve reconstruction in children.  Ann Thorac Surg. 1998;  65 1377-1380
  • 8 Casselman F P, Slycke S V, Wellens F. et al . Mitral valve surgery can now routinely be performed endoscopically.  Circul. 2003;  108 (Suppl II) II48-II54
  • 9 Smedira N G, Selman R, Cosgrove D M. et al . Repair of anterior leaflet prolapse: chordal transfer is superior to chordal shortening.  J Thorac Cardiovasc Surg. 1996;  112 287-292
  • 10 Phillips M R, Daly R C, Schaff H V. et al . Repair of anterior leaflet mitral valve prolapse: chordal replacement versus chordal shortening.  Ann Thorac Surg. 2000;  69 25-29
  • 11 David T E, Armstrong S, Sun Z. Replacement of chordae tendineae with Gore-Tex sutures: a ten-year experience.  J Heart Valve Dis. 1996;  5 352-355
  • 12 Henry W L, DeMaria A, Gramiak R. et al . Committee on nomenclature and standards in two-dimensional echocardiography.  Circul. 1980;  62 212-225
  • 13 Vetter H O, Burack J H, Factor S M. et al .Replacement of chordae tendineae of the mitral valve using the new expanded PTFE suture in sheep. Bodnar E, Yacoub M Biologic and Bioprosthetic Valves. New York; Yorke Medical Books 1986: 772-784
  • 14 Revuelty J M, Garcia-Rinaldi R, Gaite L. et al . Generation of chordae tendineae with polytetrafluoroethylene stents: results of mitral valve chordal replacement in sheep.  J Thorac Cardiovasc Surg. 1989;  97 98-103
  • 15 Cochran R P, Kunzelman K S. Comparison of viscoelastic properties of suture versus porcine mitral valve chordae tendineae.  J Card Surg. 1991;  6 508-513
  • 16 Nistal F, Garzia-Martinez V, Arbe E. et al . In vivo experiment assessment of polytetrafluoroethylene trileaflet heart valve prosthesis.  J Thoracic Cardiovasc Surg. 1990;  99 1074-1081
  • 17 Kobayashi J, Sasako Y, Bando K, Minatoya K, Niwaya K, Kitamura S. Ten-year experience of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair.  Circul. 2000;  102 (Suppl III) III30-III34
  • 18 Butany J, Collins M J, David T E. Ruptured synthetic expanded polytetrafluoroethylene chordae tendineae.  Cardiovasc Pathol. 2004;  13 182-184
  • 19 Zussa C. Different applications of ePTFE valve chordae: surgical technique.  J Heart Valve Dis. 1996;  5 356-361
  • 20 Grossi E A, Galloway A C, LaPietra A. et al . Minimally invasive mitral valve surgery: a 6-year experience with 714 patients.  Ann Thorac Surg. 2002;  74 660-664

MD Petar S. Risteski

Department of Thoracic and Cardiovascular Surgery
Johann Wolfgang Goethe University

Theodor-Stern-Kai 7

60590 Frankfurt am Main

Germany

Phone: + 49 69 63 01 61 41

Fax: + 49 69 63 01 58 49

Email: docpsr@yahoo.com