Repair of anterior leaflet mitral valve prolapse: chordal replacement versus chordal shortening.
BACKGROUND
To determine the optimal method of repair for severe, segmental anterior leaflet prolapse, we analyzed outcome of 121 patients who underwent chordal shortening (n = 46) and chordal replacement (n = 75) from 1988 to 1996.


METHODS
Chordae were replaced with expanded polytetrafluoroethylene sutures. Patients had an annuloplasty with either chordal replacement or shortening. Follow-up was 100% complete (mean, 3.7 years).


RESULTS
Mean age was 62.1 years, 86 were men, and 60 patients had isolated valve repair. There was one hospital death and 14 late deaths for a 5-year actuarial survival of 86.4%+/-4.5%. Sixteen patients underwent reoperation, 5 in the replacement group and 11 in the shortening group. Mechanism of valve failure in the replacement group was native chordae rupture (n = 4) and neochordae dehiscence (n = 1). With chordal shortening, repair failure was attributed to rupture of shortened chordae (n = 8), leaflet prolapse with and without annuloplasty ring dehiscence (n = 2), and native chordae elongation (n = 1). Risk of reoperation because of repair failure at 3.5 years was 1.4% in the chordal replacement group and 14.8% in the chordal shortening group (p = 0.02).


CONCLUSIONS
Chordal replacement is superior to chordal shortening, providing a predictable method for correction of mitral regurgitation with a low incidence of reoperation.
Phillips
M R
MR
Division of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Daly
R C
RC
Schaff
H V
HV
Dearani
J A
JA
Mullany
C J
CJ
Orszulak
T A
TA
D000206:Actuarial Analysis; D000704:Analysis of Variance; D002423:Cause of Death; D002815:Chordae Tendineae / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000601:surgery*; D010210:Papillary Muscles / Q000601:surgery; D011138:Polytetrafluoroethylene; D016016:Proportional Hazards Models; D012086:Reoperation; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013529:Surgical Wound Dehiscence / Q000209:etiology; D015996:Survival Rate; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation; D013537:Sutures; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene