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Twenty-Year Experience of Mitral Valve Repair with Artificial Chordae in 608 Patients.
L. Salvador, S. Mirone, R. Bianchini, T. Regesta, F. Patelli, G. Minniti, M. Masat, E. Cavarretta, C. Valfrè. Treviso Ca' Foncello Hospital - Cardiac Surgery, Treviso, Italy,
BACKGROUND:
Mitral valve repair with artificial neochordae, for degenerative mitral regurgitation, is a widely adopted technique, but to our knowledge, this is the longest follow-up study. We sought to evaluate the very long-term results of mitral valve repair, for mitral regurgitation, with expanded-polytetrafluoroethylene (e-PTFE ,Gore-Tex® CV-5) sutures.
METHODS:
Between November 1986 and November 2006, 608 consecutive patients, affected by severe mitral regurgitation, underwent mitral valve repair with artificial neochordae implant. Mean age was 55.5±11.5 (range 15-85 years) and 433 (71.6%) were men. The cause of valve disease was pure degenerative in 539 (88.7%) patients. Anterior leaflet, posterior or both leaflets prolapse was present in 47 patients (7.7%), 308 (50.7%) and 253 (41.6%), respectively. Gore-Tex® neochordae were used to repair the anterior leaflet in 56 (9.2%) patients, the posterior in 291 (47.9%) and both in 261 (42.9%) patients. Atrial fibrillation was associated in 117 patients (19.2%) and Maze procedure was performed in 44 selected patients (7.2%) since 2000. In 126 patients (20.7%), additional surgical procedures, other than mitral repair, were performed. Echocardiographic Doppler studies were obtained annually and clinical follow-up was complete at a mean of 7±4 years (range 0-20 years).
RESULTS:
The in-hospital mortality was <1% (6 deaths), overall and cardiac late mortality 6% and 3.3% (38 and 20 deaths), respectively. Kaplan-Meier survival at 15 years was 81±6%. Freedom from endocarditis, thromboembolic event (transitory ischemic attack and stroke) and reoperation at 15 years were 98±1%, 91±2% and 80±7%, respectively. At 3±1.5 year follow-up, sinus rhythm was restored in 82% (36 patients) who underwent Maze procedure. Calcification of Gore-Tex® neochordae was never reported at explantation neither documented with transthoracic echocardiography.
CONCLUSIONS:
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 very long-term follow-up. Artificial chordae show an excellent biological adaptation retaining their normal flexibility and tension over time without calcification and are a useful tool to treat complex lesions involving the anterior or both anterior and posterior leaflet, providing long-term durability of mitral valve repair. 
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