title: A 25-year study of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair†.
abstract: OBJECTIVE
  This study examines the outcome of mitral valve repair with chordal replacement using expanded polytetrafluoroethylene over the past 25 years.
  
  
  METHODS
  From July 1988 to February 2013, 224 consecutive patients (mean age 57 years, 34% women) underwent mitral valve repair with chordal replacement using expanded polytetrafluoroethylene sutures at our institution. Isolated anterior leaflet prolapse was observed in 134 patients (60%), isolated posterior leaflet prolapse was observed in 13 patients (6%) and bileaflet prolapse was observed in 77 patients (34%). The number of replaced artificial chordae ranged from 2 to 12 (mean 3.7) per patient. Transthoracic echocardiography was performed pre- and postoperatively and in the follow-up period. The follow-up period ranged from 0.3 to 25.3 years (mean 7.4, median 6.2).
  
  
  RESULTS
  There was 1 early death and 15 late deaths, of which 7 were cardiac related. The actuarial survival rates at 10 and 20 years were 92 and 81%, respectively. Thirty-three patients (15%) developed recurrent moderate or severe mitral regurgitation during the follow-up period and 30 patients (13%) required reoperation on the mitral valve. Rates of freedom from reoperation and freedom from recurrent moderate or severe mitral regurgitation were 84 and 82% at 10 years, and 74 and 59% at 20 years, respectively. Multivariate analysis revealed that the independent predictors of recurrent mitral regurgitation were mitral valve repair without annuloplasty ring and greater than mild postoperative mitral regurgitation; and the independent predictors of mitral reoperation were previous cardiac surgery and greater than mild postoperative mitral regurgitation. Histopathological analysis of the expanded polytetrafluoroethylene sutures removed during reoperation revealed complete endothelialization without calcification or microthrombi.
  
  
  CONCLUSIONS
  Our 25-year follow-up demonstrated reliable long-term outcomes of chordal replacement with expanded polytetrafluoroethylene sutures.
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan hatahiro@ncvc.go.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hata
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimahara
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
mesh_terms: D000328:Adult; D000368:Aged; D002815:Chordae Tendineae / Q000503:physiopathology / Q000601:surgery*; D018572:Disease-Free Survival; D004867:Equipment Design; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene
keywords: Chordal replacement; Expanded polytetrafluoroethylene; Mitral valve repair