Long-term results of artificial chordae implantation in patients with mitral valve prolapse.
OBJECTIVE
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.
Eishi
K
K
Division of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Kawazoe
K
K
Nakano
K
K
Kosakai
Y
Y
Sasako
Y
Y
Kobayashi
J
J
D002815:Chordae Tendineae / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000401:mortality; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D011788:Quality of Life; D015996:Survival Rate; D013536:Suture Techniques; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene