Artificial mitral valve chordae: experimental and clinical experience

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Medical Devices

Background:

• Mitral valve reconstructive surgery can fail due to subvalvular apparatus damage.
• Artificial chordae tendineae are crucial for maintaining mitral valve function.

Purpose of the Study:

• To evaluate the efficacy of expanded polytetrafluoroethylene (ePTFE) sutures for mitral valve chordae replacement.
• To assess the long-term outcomes of ePTFE chordae implantation in patients with mitral valve disease.

Main Methods:

• ePTFE sutures were used to replace anterior leaflet mitral valve chordae in 8 animals (dogs and sheep).
• Following positive animal study results, 5-0 ePTFE sutures were implanted in 12 human patients with degenerative or rheumatic mitral valve disease.
• Intraoperative outcomes and long-term hemodynamic results were monitored.

Main Results:

• Animal studies showed positive results over a 13-month follow-up.
• In humans, 3 patients required prosthetic valve insertion due to unacceptable intraoperative results.
• One late failure occurred due to natural chorda rupture 18 months post-procedure.
• Remaining patients demonstrated satisfactory hemodynamic results with no valve-related events up to 30 months post-operation.

Conclusions:

• 5-0 ePTFE sutures are a viable option for anterior leaflet mitral valve chordae replacement.
• This technique shows potential for treating degenerative, rheumatic, and congenital mitral valve diseases.
• Supportive artificial chordae implantation is recommended for diffuse natural chorda alterations.