Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: a 25-year experience.
OBJECTIVE
The study objective was to examine the late results of mitral valve repair with chordal replacement with polytetrafluoroethylene sutures.


METHODS
From 1986 to 2004, 606 consecutive patients with degenerative mitral regurgitation had mitral valve repair with chordal replacement with polytetrafluoroethylene sutures. Patients' mean age was 57 years, and 73.6% were men. Isolated prolapse of the anterior leaflet was present in 17.6% of patients, isolated posterior leaflet prolapse was present in 29.5% of patients, and bileaflet prolapse was present in 52.9% of patients. Prolapse was corrected by creating 2 to 38 neochords of polytetrafluoroethylene sutures (mean, 13 ± 9 per patient). The mean follow-up was 10.1 years, and 96% of the patients had multiple echocardiographic studies over the years.


RESULTS
There were 5 early and 106 late deaths. Age, diabetes, hypertension, chronic obstructive lung disease, New York Heart Association functional classes III and IV, and ejection fraction less than 40% were independent predictors of mortality. At 18 years, freedom from reoperation on the mitral valve was 90.2% ± 2.4%, freedom from recurrent severe mitral regurgitation was 91.0% ± 2.7%, and freedom from moderate or severe mitral regurgitation was 67.5% ± 4.2%. Cox regression analysis revealed that isolated prolapse of the anterior leaflet was predictive of reoperation, and that older age, hypertension, and left ventricular ejection fraction less than 40% were predictive of recurrent moderate or severe mitral regurgitation.


CONCLUSIONS
Chordal replacement with polytetrafluoroethylene sutures expands the indication of repair to patients with prolapse of multiple segments. Valve function remains stable in most patients during the first 2 decades of follow-up.
Division of Cardiovascular Surgery of Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.ca
Tirone E
TE
David
Susan
S
Armstrong
Joan
J
Ivanov
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002815:Chordae Tendineae / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D015996:Survival Rate; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene