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Long-term results of artificial chordae implantation in patients with mitral valve prolapse
1Division of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Background And Aims Of The Study:
In terms of valve-related complication and ventricular function, mitral valve repair (MVR) is superior to valve replacement. To date, chordae shortening and transposition have been used for diffuse prolapses. We have used artificial chordae implantation for MVR since 1986, and here review our long-term results.
Methods:
Pericardial strips were used in nine patients, and e-PTFE (Gore-Tex) sutures in 58. A degenerative lesion was present in 69% of cases, endocarditis in 16% and rheumatic valvulitis in 7%. Implantation of artificial chordae was indicated for treatment of diffuse prolapse. Annuloplasty was performed in patients with or without prosthetic ring.
Results:
Actuarial survival rate was 78% for the pericardial chordae group at nine years, and 94% for the Gore-Tex chordae group at eight years. Thromboembolic events occurred in two pericardial chordae patients, and three Gore-Tex chordae patients required reoperation. Freedom from reoperation was 100% for pericardial chordae after nine years and 96% for Gore-Tex chordae after eight years. Quality of life among survivors is good: 83% are in NYHA class I, 89% are free from anticoagulation, and 60% require no medication. Mitral valve orifice area, estimated echocardiographically, was similar in both groups at discharge and at follow up.
Conclusions:
MVR with artificial chordae provided satisfactory valve function for up to nine years. Gore-Tex chordae are less prone to deterioration than pericardial chordae. Follow up observations support the use e-PTFE chordae to correct diffuse leaflet prolapse.
Insights
Mitral valve repair using artificial chordae, particularly e-PTFE (Gore-Tex), offers excellent long-term function and survival. This method is a viable option for treating diffuse mitral valve prolapse.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Biomaterials in Medicine
Background:
- Mitral valve repair (MVR) is preferred over replacement for better valve function and fewer complications.
- Traditional methods for diffuse mitral valve prolapse include chordae shortening and transposition.
- Artificial chordae implantation has been utilized for MVR since 1986.
Purpose of the Study:
- To review the long-term outcomes of mitral valve repair using artificial chordae implantation.
- To compare the efficacy of pericardial strips versus e-PTFE (Gore-Tex) sutures for artificial chordae.
Main Methods:
- Artificial chordae were implanted in 67 patients (9 with pericardial strips, 58 with e-PTFE sutures).
- Indications included degenerative lesions (69%), endocarditis (16%), and rheumatic valvulitis (7%).
- Annuloplasty was performed in conjunction with artificial chordae implantation.
Main Results:
- Actuarial survival rates were 78% (pericardial) and 94% (Gore-Tex) at 8-9 years.
- Freedom from reoperation was 100% (pericardial) and 96% (Gore-Tex) at 8-9 years.
- Survivors reported good quality of life, with 83% in NYHA class I and 89% free from anticoagulation.
Conclusions:
- Mitral valve repair with artificial chordae provides satisfactory long-term valve function.
- e-PTFE (Gore-Tex) chordae demonstrate superior durability compared to pericardial chordae.
- Artificial chordae, especially e-PTFE, are recommended for correcting diffuse mitral leaflet prolapse.