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

Abstract

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.

Early and mid-term results of mitral valve repair using premeasured Gore-Tex loops (‘loop technique’)☆

“…Gore & Associates, Flagstaff, AZ) was introduced in 1980s by David et al [3,4] and Frater et al [5]. These surgeons used and propagated their techniques for correction of anterior leaflet prolapse and demonstrated excellent early-and long-term results [6,7]. This technique is complicated by difficulties in achieving reproducible neochordal length, however, resulting in a lack of widespread adoption by most surgeons.…”

Surgical repair of chordae tendineae rupture after degenerative valvular regurgitation using standardized bovine pericardium

“…The PTFE threads, proposed by David et al [8] have been shown to be more frequently used in the world. A recent study using PTFE showed excellent results at five and 10 years postoperatively, with no reoperation in 93.3% and 81.7%, respectively [19]. However, the use of these techniques requires enormous degree of subjectivity, requiring a high degree of individual skill.…”

Dynamic evaluation of the loop technique using the U-Clip

“…After the slack loop was refixed to the preferred position, the loop was strained. [1][2][3][4][5] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/AANJ/Vol00000/130254/APPFile/SG-AANJ130254.3d (AAN) [PREPRINTER stage] 3.19 kgÁmÁs À2 , respectively. 8 According to our traction test, the mean value of the tractive force when the UClips came off the papillary muscle was 8.55 kgÁmÁs À2 .…”