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Published on: December 11, 2017
Fifteen years' experience with the use of artificial chords for valve reconstruction in children
Jolanda Kluin1,2, Vladimir Sojak1,2, David R Koolbergen1,2
1Department of Cardiothoracic Surgery, Leiden University Center, Leiden, Netherlands.
Insights
Artificial chords provide good long-term durability for mitral and tricuspid valve reconstruction in children. This surgical technique minimizes issues like restricted leaflet motion, even as children grow.
Area of Science:
- Pediatric Cardiac Surgery
- Valvular Heart Disease Reconstruction
- Biomaterials in Medicine
Background:
- Congenital heart defects often necessitate valve repair in pediatric patients.
- Artificial chords offer a potential solution for mitral and tricuspid valve reconstruction in children.
- Assessing the long-term efficacy and safety of artificial chords in pediatric valvular surgery is crucial.
Purpose of the Study:
- To evaluate the outcomes of using artificial chords for mitral and tricuspid valve reconstruction in pediatric patients.
- To assess the durability and potential complications associated with artificial chord use in this population.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) undergoing mitral or tricuspid valve reconstruction with artificial chords over 15 years.
- Detailed review of surgical techniques, including annuloplasty, and follow-up data.
- Actuarial analysis of freedom from reoperation rates.
Main Results:
- Thirty-nine pediatric patients (27 mitral, 12 tricuspid) received artificial chords.
- No early or late mortality was observed.
- Actuarial freedom from reoperation rates at 1, 5, and 10 years were 95%, 91%, and 81%, respectively, with no reoperations in the tricuspid group.
Conclusions:
- Mitral and tricuspid valve reconstruction using artificial chords demonstrates good long-term durability in children.
- Restricted leaflet motion due to artificial chords is not a significant problem, even with patient growth.
Objectives:
To retrospectively review our experience with artificial chords in mitral and tricuspid reconstructive surgery in children.
Methods:
All consecutive paediatric (<18 years) patients who underwent mitral or tricuspid valve reconstruction with the use of artificial chords in our centre in the past 15 years were retrospectively analysed.
Results:
Thirty-nine patients (age 3 days to 17 years) underwent reconstruction of the mitral (n = 27) or tricuspid (n = 12) valve using artificial chords. Mean number of chords was 3.5 ± 1.7. In 26 of 27 mitral valve patients, chords were placed on the anterior leaflet, in one on the posterior leaflet. In 10 of the 12 tricupid valve, patients chords were placed on the anterior leaflet and in 2 on the septal leaflet. All mitral patients underwent annuloplasty (10 bilateral Wooler-Kay and 17 rigid ring annuloplasty). Ten of the 12 tricuspid patients underwent annuloplasty (1 rigid ring and 9 commissural plication). Follow-up was after 8.7 ± 5.5 years. There was no early or late mortality. The actuarial freedom from reoperation rates at 1, 5 and 10 years were 95%, 91% and 81%, respectively. No reoperations occurred in the tricuspid group. In the mitral group, there were 2 early failures and 3 late reoperations due to mitral stenosis. Restricted leaflet motion probably caused by the artificial chords was seen in only 1 patient.
Conclusions:
Our data show that long-term durability of mitral and tricuspid valve reconstruction using artificial chords in children is good. Despite patient growth, restricted leaflet motion by the artificial chords does not seem to form a major problem.
