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J Thorac Cardiovasc Surg 2008;135:1280-1287
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

A 20-year experience with mitral valve repair with artificial chordae in 608 patients

Division of Cardiac Surgery of Santa Maria dei Battuti Hospital, Treviso, Italy

Received for publication June 23, 2007; revisions received December 20, 2007; accepted for publication December 27, 2007.

^_* Address for reprints: Loris Salvador, MD, FECTS, Department of Cardiac Surgery, Santa Maria dei Battuti Hospital, Piazza Ospedale 1, 31100 Treviso, Italy. (Email: medloris{at}yahoo.it).

Objective: Mitral valve repair with artificial chordae for degenerative mitral regurgitation is widely adopted. We evaluated long-term results of mitral repair with expanded polytetrafluoroethylene sutures (GORE-TEX CV-5; W. L. Gore & Associates, Inc, Flagstaff, Ariz).

Methods: Between November 1986 and November 2006, 608 consecutive patients underwent mitral repair with artificial neochordae. Mean age was 55 ± 11 years (15–85 years); 433 (71.2%) were male. Valve disease was purely degenerative in 555 patients (91.3%). Prolapse of anterior, posterior, or both leaflets was present in 47 (7.7%), 308 (50.7%), and 253 (41.6%), respectively. Atrial fibrillation was associated in 117 (19.2%). In 125 cases (20.5%), additional surgical procedures were performed. Follow-up was complete at a median of 5.7 years (interquartile range 2.2–9.8 years, range 0–19.4 years).

Results: In-hospital mortality was less than 1% (6 deaths). Overall and cardiac late mortalities were 6.6% and 3.9% (34 and 24 deaths). Kaplan–Meier survival at 15 years was 84% (95% confidence interval 75%–90%). Freedoms from endocarditis, thromboembolic events, reoperation, and recurrent mitral regurgitation at 15 years were 97% (95% confidence interval 93%–99%), 92% (87%–95%), 92% (88%–95%), and 85% (78%–91%), respectively. Sinus rhythm was restored in 75% (33 patients) after surgical atrial fibrillation correction. Calcification of GORE-TEX neochordae was never reported.

Conclusion: Mitral valve repair with GORE-TEX artificial chordae is effective, safe, and associated with low operative mortality and low rates of valve-related complications at long-term follow-up. Artificial chordae showed excellent biologic adaptation, retaining flexibility and tension with time.

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