title: A 17-year experience with mitral valve repair with artificial chordae in infants and children.
abstract: OBJECTIVE
  We sought to examine our long-term results of mitral valve (MV) repair with expanded polytetrafluoroethylene (ePTFE) sutures and to determine the predictors for the outcome of this procedure.
  
  
  METHODS
  Between 1995 and 2011, MV repair with chordal reconstruction by artificial chordae was achieved in 78 patients (34 males and 44 females). Median age at repair was 1.5 years (range 3.6 months-13.4) and weight was 9.1 kg (2.5-31.4). The mean follow-up was 8.3 years. A Cox proportional hazards model was used to analyse the risk factors for a composite outcome of death, conversion to other MV repair techniques or MV replacement, reoperation on MV and recurrent mitral regurgitation (MR).
  
  
  RESULTS
  According to Carpentier classification, 65 (83.3%) patients were Type 2 and 13 (16.7%) were Type 3. Mitral annuloplasty was performed in all cases, except 2. During MV repair, 8 (10.3%) patients were ineffective with artificial chordae and converted to other techniques. Six (7.7%) patients underwent MV reoperation (three repairs and three replacements). Freedom from MV reoperation was 92.5 and 90.4% at 5 and 10 years, respectively. There was 1 in-hospital death. At the latest follow-up, moderate or more MR was observed in 3 (3.8%) patients. Risks for the composite outcome were low body weight at operation and Carpentier classification Type 3.
  
  
  CONCLUSIONS
  MV repair with artificial chordae in infants and children is safe and effective and associated with a low reoperation rate. Further investigation into the long-term durability and biological adaptation of ePTFE sutures after patient growth is mandatory.
authors.affiliation: Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan. shinoda@heart.med.kyushu-u.ac.jp
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Oda
authors.forename: Toshihide
authors.initials: T
authors.lastname: Nakano
authors.forename: Hideki
authors.initials: H
authors.lastname: Tatewaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hinokiyama
authors.forename: Daisuke
authors.initials: D
authors.lastname: Machida
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kado
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013537:Sutures; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene
keywords: Artificial chordae; Congenital heart disease; Expanded polytetrafluoroethylene; Long-term outcome; Mitral valve repair