Different applications of ePTFE valve chordae: surgical technique

Artificial chordae made of ePTFE have been used for mitral valve repair for 10 years. The positive results obtained in experimental and clinical series have led to the extension of their clinical indications to mitral valve replacement and tricuspid valve repair. The different technical aspects of each of these applications are illustrated.

Artificial chordae were implanted in 223 patients undergoing mitral valve repair. Seven of them had the valve replaced during the same operation due to an unsatisfactory result. Two patients died in the postoperative period. During a mean follow up of 38.1 months (range 2-114 months), two more patients died, while three reoperations were required; one thromboembolic event was reported and the actuarial rates of patient survival and event-free survival were 98.0% and 95.8%, respectively, at nine years. In 31 cases of mitral valve replacement, with unavoidable removal of the entire subvalvular apparatus, ventricular wall-mitral annulus continuity was restored with the insertion of artificial chordae. None of these patients died early or during a mean follow up of 25.2 months (range 2-110 months), in which only one thromboembolic event was reported. In five cases of tricuspid valve insufficiency in which traditional techniques of repair were inadequate, valve replacement was avoided with the application of artificial chordae. None of these patients experienced any early or late complications.

Based on this experience these procedures are safe, reproducible and reliable. They are a valuable support for other traditional techniques, allowing the indications for mitral and tricuspid valve repair to be extended, and restoring the ventricular-annular continuity in case of mitral valve replacement.