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

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• 作者：Loris Salvador ; Salvatore Mirone ; Roberto Bianchini ; Tommaso Regesta ; Fabio Patelli ; Giuseppe Minniti ; Mauro Masat ; Elena Cavarretta ; Carlo Valfrè
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2008
• 出版时间：June 2008
• 年：2008
• 卷：135
• 期：6
• 页码：1280-1287.e1
• 全文大小：422 K

文摘

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.