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Loris Salvador
Salvatore Mirone
Roberto Bianchini
Tommaso Regesta
Giuseppe Minniti
Carlo Valfrè
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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

Loris Salvador, MD*, Salvatore Mirone, MD, Roberto Bianchini, MD, Tommaso Regesta, MD, Fabio Patelli, MD, Giuseppe Minniti, MD, Mauro Masat, MD, Elena Cavarretta, MD, Carlo Valfrè, MD

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.

Abbreviations and Acronyms AF = atrial fibrillation; CI = confidence interval; ePTFE = expanded polytetrafluoroethylene; IQR = interquartile range; MR = mitral regurgitation; MV = mitral valve; SAM = systolic anterior motion


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Discussion
J. Thorac. Cardiovasc. Surg. 2008 135: 1287. [Extract] [Full Text] [PDF]





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