Premolded bovine pericardial chords for replacement of ruptured or elongated chordae tendineae

The aim of this study was to assess by Doppler echocardiography (ECO) the functioning of the mitral valve apparatus in patients who have undergone implantation of standardized bovine pericardium chordae (SBPC) for replacement of ruptured or elongated chordae tendineae with significant thinning.

SBPC were implanted in 31 patients who had mitral insufficiency due to rupture of chordae tendinae or elongated chordae with significant thinning. Patient ages ranged from 19 to 85 years (mean of 58 years). The most frequent cause of mitral insufficiency was fibroelastic degeneration in 25 patients (80.6%). The SBPC were fashioned as a set, joined at their extremities by 2 polyester-reinforced rods forming a monobloc. The SBPC were 2-mm wide and were positioned parallel to one another at a distance of 3 mm. Each set of SBPC had a corresponding measurer, and their length ranged from 20 to 35 mm. In 21 patients (67.7%) the SBPC were implanted in the posterior leaflet and in 10 patients (32.3%) in the anterior leaflet (in 2 patients concurrently in the anterior and posterior leaflets). All patients were assessed by ECO postoperatively, with a 20-month mean follow-up time (range 6-45 months).

One patient (3.2%) died of pulmonary embolism during the early postoperative period. Postoperative ECO showed absence of mitral regurgitation in 17 patients (54.8%), mild regurgitation in 9 (29.0%), and mild-to-moderate regurgitation in 4 (12.9%). Opening and mobility of the mitral valve were normal in the 30 surviving patients.

The ECO revealed good functionality of the mitral valve apparatus with appropriate leaflet coaptation in patients who had undergone implantation of SBPC for replacement of ruptured or elongated and thinned chordae. A longer follow-up is required to assess absence of calcification and/or degeneration of the SBPC.