Generation of chordae tendineae with polytetrafluoroethylene stents

Revuelta, José M.; García‐Rinaldi, Raúl; Gaite, Luis; Val, Fernando; Garijo, F.

doi:10.1016/s0022-5223(19)35132-3

Cited by 64 publications

(23 citation statements)

References 13 publications

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“…Chordal replacement of ePTFE is an alternative technique that was initiated after experimental study. 19 In the present study, actuarial rates of freedom from reoperation were 94% at 5 years and 82% at 10 years. David et al 20 reported a rate of freedom from reoperation of 94% at 10 years.…”

Section: Discussionsupporting

confidence: 44%

Ten-Year Experience of Chordal Replacement With Expanded Polytetrafluoroethylene in Mitral Valve Repair

Kobayashi¹,

Sasako²,

Bando³

et al. 2000

Circulation

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Background-Mitral valve repair is the procedure of choice to correct mitral regurgitation (MR). Although chordal replacement with expanded polytetrafluoroethylene (ePTFE) has been widely accepted to repair anterior mitral prolapse and other difficult situations, the long-term results of the repair and the fate of ePTFE have not been delineated. Methods and Results-From July 1988 to April 1999, 74 patients (49 males, 25 females) aged 17 to 77 years (mean age 55.3Ϯ14.8 years) underwent mitral valve repair with chordal replacement with ePTFE. The follow-up period was from 6 months to 11.3 years (mean 4.6Ϯ3.2 years). The causes of MR were degenerative in 65 patients (88%) and infective in 9 (12%). Three patients had active infective endocarditis. Valve lesions were anterior in 35 patients, posterior in 10, and both anterior and posterior in 29. Various procedures for plasty of leaflets were necessary in 37 patients (50%). Atrial fibrillation was associated in 38 patients (51%), and the maze procedure has been performed in a selected group of 30 patients (41%) since July 1992. There was 1 in-hospital death (1.4%) and 3 late cardiac deaths (4.1%). More than moderate MR developed in 12 patients (17%) during the follow-up period. Three of these patients required early reoperation within 1 year due to hemolysis. Two patients underwent mitral valve replacement at 6 and 8 years after repair, respectively. The actuarial reoperation-free rates at 5 and 10 years were 94.3Ϯ2.8% and 81.7Ϯ9.1%, respectively. Sinus rhythm was restored in 21 patients (70%) with the maze procedure. There was only 1 thromboembolic episode (0.3%/patient-y) in a patient with atrial fibrillation who did not undergo the maze procedure. Event-free survival rates as assessed by the freedom from cardiac death, thromboembolism, reoperation, and anticoagulation-related hemorrhage at 5 and 10 years were 91.3Ϯ3.4% and 71.6Ϯ9.7%, respectively. There was no relationship between recurrent MR and the change of ePTFE. Structural analysis of the ePTFE resected during reoperation revealed no calcification and showed remaining flexibility and pliability. Protein infiltration was observed in the ePTFE, and collagenous proliferation was recognized at the site of fixation to the valve leaflet and the papillary muscle. The surface of the ePTFE was completely endothelialized, which may induce antithrombogenicity. Conclusions-The long-term durability and biological adaptation of ePTFE as artificial chordae for mitral valve repair of MR were proved for Ͼ10 years. (Circulation. 2000;102[suppl III]:III-30-III-34.

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Section: Discussionsupporting

confidence: 44%

Ten-Year Experience of Chordal Replacement With Expanded Polytetrafluoroethylene in Mitral Valve Repair

Kobayashi¹,

Sasako²,

Bando³

et al. 2000

Circulation

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“…For example, there is an approximate 13% recurrence rate of mild regurgitation in the long-term after mitral valve repair [11]. Chordal replacement is the current standard for chordae repair, in which the ruptured chordae is replaced with a synthetic material such as expanded polytetrafluoroethylene (ePTFE) sutures [10,12]. Despite the prevalence of the procedure, there are still issues such as elongation of the synthetic chordae, rupture of the native chordae, calcification, or recurrent prolapse potentially caused by an elastic modulus higher than that of the native chordae [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Mechanics and Microstructure of the Atrioventricular Heart Valve Chordae Tendineae: A Review

Ross

Zheng

et al. 2020

Bioengineering

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The atrioventricular heart valves (AHVs) are responsible for directing unidirectional blood flow through the heart by properly opening and closing the valve leaflets, which are supported in their function by the chordae tendineae and the papillary muscles. Specifically, the chordae tendineae are critical to distributing forces during systolic closure from the leaflets to the papillary muscles, preventing leaflet prolapse and consequent regurgitation. Current therapies for chordae failure have issues of disease recurrence or suboptimal treatment outcomes. To improve those therapies, researchers have sought to better understand the mechanics and microstructure of the chordae tendineae of the AHVs. The intricate structures of the chordae tendineae have become of increasing interest in recent literature, and there are several key findings that have not been comprehensively summarized in one review. Therefore, in this review paper, we will provide a summary of the current state of biomechanical and microstructural characterizations of the chordae tendineae, and also discuss perspectives for future studies that will aid in a better understanding of the tissue mechanics–microstructure linking of the AHVs’ chordae tendineae, and thereby improve the therapeutics for heart valve diseases caused by chordae failures.

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“…The chordae tendineae study is relevant because the possibility of surgical repair or replacement by different materials (Revuelta et al, 1989). Considering that experimental models are necessary to develop new approaches, we studied swine and human chordae tendineae.…”

Section: Introductionmentioning

confidence: 99%

Chordae Tendineae Architecture in the Papillary Muscle Insertion

2004

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Chordae tendineae architecture and their junction with papillary muscle were studied with scanning electron microscopy, comparing human and swine hearts. Papillary muscles with the corresponding chordae tendineae were obtained from human and pig (Sus scrofa) hearts after exposition of the left ventricle cavity, fixed with 4% formaldehyde. The specimens were sectioned in small samples and divided in four groups, a control one and the others submitted to digestion in a solution of 2.5% sodium hypochlorite in saline solution during 5, 10 and 15 minutes respectively. The specimens were washed and fixed in 1% osmium tetroxide in cacodylate buffer, kept in 1% tannic acid for 30 minutes, dehydrated and critical point dried, mounted and sputtered with gold. The specimens were examined and documented in a JEOL 5200 scanning electron microscope. The human and swine chordae tendineae have similar architecture: both are covered by the endothelium which was in continuity with the papillary muscles, the inner layers are composed by longitudinal and oblique collagen bundles intermingled with elastic fibers. Differences between swine and human hearts were found in the chordae tendineaepapillary muscle junction. In the human heart the collagen bundles showed a more organized arrangement, forming a meshwork with the fibers disposed in approximately orthogonal angles, whereas in the swine heart the fibers were randomly disposed.

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Generation of chordae tendineae with polytetrafluoroethylene stents

Cited by 64 publications

References 13 publications

Ten-Year Experience of Chordal Replacement With Expanded Polytetrafluoroethylene in Mitral Valve Repair

Ten-Year Experience of Chordal Replacement With Expanded Polytetrafluoroethylene in Mitral Valve Repair

Mechanics and Microstructure of the Atrioventricular Heart Valve Chordae Tendineae: A Review

Chordae Tendineae Architecture in the Papillary Muscle Insertion

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