Format

Send to

Choose Destination
J Thorac Cardiovasc Surg. 2019 Aug 30. pii: S0022-5223(19)31693-9. doi: 10.1016/j.jtcvs.2019.08.006. [Epub ahead of print]

Long-term outcomes of chordal replacement with expanded polytetrafluoroethylene sutures to repair mitral leaflet prolapse.

Author information

1
Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, and University of Toronto, Toronto, Ontario, Canada. Electronic address: susan.peters@uhn.ca.
2
Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, and University of Toronto, Toronto, Ontario, Canada.

Abstract

OBJECTIVES:

This study examines the durability of mitral valve (MV) repair for mitral regurgitation using chordal replacement with expanded polytetrafluoroethylene sutures to correct leaflet prolapse.

METHODS:

Isolated chordal replacement was used to correct prolapse in 186 (24.9%) patients and combined with leaflet resection in 560 (75.1%). Patients were followed prospectively with periodical clinical and echocardiographic assessments for a median follow-up of 11 years (range, 7-16 years).

RESULTS:

Patients' median age was 58 years (range, 48-67 years) and 516 (69.2%) were men. Bileaflet prolapse was present in 63% of patients and advanced myxomatous degeneration was present in 32%. The number of neochords per repaired valve increased over time and was not associated with MV reoperation or recurrent mitral regurgitation. The cumulative incidence of MV reoperation with death as a competing risk was 4.2% (95% confidence interval [CI], 2.4-6.0) at 20 years. Multivariable analysis revealed that previous cardiac operations (hazard ratio, 5.70; 95% CI, 1.96-16.53; P = .001), and isolated anterior leaflet prolapse (hazard ratio, 3.92; 95% CI, 1.106-13.91; P = .034) were associated with increased hazard of MV reoperation. The probability of recurrent moderate or severe mitral regurgitation using repeated measures regression models was 14.1% (95% CI, 10.3-19.0) at 20 years. Variables associated with recurrent MR in multivariable regression analysis were left ventricular ejection <40% (hazard ratio, 3.57; 95% CI, 1.37-9.32; P = .009) and preoperative complete heart block (hazard ratio, 5.90; 95% CI, 2.47-14.09; P < .001).

CONCLUSIONS:

Chordal replacement with expanded polytetrafluoroethylene sutures provides stable MV function in most patients during the first 2 decades of follow-up.

KEYWORDS:

chordal replacement with expanded polytetrafluoroethylene sutures; mitral valve prolapse; mitral valve repair

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center