Long-term results of cusp-level chordal shortening for anterior mitral leaflet prolapse

The technique and early results of cusp-level chordal shortening for isolated anterior mitral leaflet prolapse in rheumatic mitral regurgitation were presented by us earlier. Here we present our experience from January 1989 through December 2000. Two hundred twenty-six patients underwent this procedure. The mean age was 18 +/- 7.22 years. Preoperatively, 38 (16.8%) patients were in New York Heart Association functional class 11, 160 (70.8%) were in class IIl, and 28 (12.4%) were in class IV. All patients underwent chordal shortening at the cusp level. In addition, 8 patients (3.5%) underwent chordal transfer, and 4 patients (1.8%) received neochordae. Two hundred twenty-one (97.8%) patients underwent posterior annuloplasty using a C-shaped polytetrafluoroethylene collar. In 85 (37.6%) patients, cuspal thinning was also performed. Early mortality was 3.5% (8 patients). Follow-up ranged from 1 to 144 months (mean, 53.02 +/- 31.10 months) and was 94% complete. In 68% of survivors, there was no or trivial mitral regurgitation. Ten patients required reoperation. There were 8 late deaths. Actuarial survival, mitral regurgitation-free survival, and event-free survival were 93.3% +/- 1.7%, 41.8% +/- 8.4%, and 73.6% +/- 6.6%, respectively. Among the 210 survivors, 159 (75.7%) were in New York Heart Association class I, 26 (12.4%) were in class II, 22 (10.5%) were in class III, and 3 (1.4%) were in class IV. We conclude that cusp-level chordal shortening for isolated anterior mitral leaflet prolapse is an effective procedure for correction of anterior mitral leaflet prolapse.