Artificial chordae for mitral valve repair: Mid-term clinical and echocardiographic results

Background: This paper reports on the mid-term clinical and echocardiographic results of mitral valve repair with chordal replacement. Methods: Sixty-nine patients (mean age 61 +/- 14 years) underwent mitral valve repair with chordal replacement. The etiology was degenerative in 53 (77%), rheumatic in 7 (10%), ischemic in 6 (9%) and infective in 3 (4%). Mean ejection fraction was 58 +/- 14. In 35 patients (51%), a minimally invasive approach was used. Mean follow-up time was 45 +/- 27 months. Results: Anterior leaflet chordae were replaced in 58 (84%) patients. There were 3 operative deaths. Freedom from non-trivial recurrent mitral regurgitation (MR) was 81.3 +/- 8.7% at 97 months. Follow-up echocardiographic controls showed mild recurrent MR in 5 (8%) patients and moderate in 2 (3.2%). These two patients required reoperation due to mitral annulus redilation after suture annuloplasty. Competent neochordae were found at reoperation. Freedom from reoperation at 97 months was 96.6 +/- 2.4%. Four patients died during follow-up resulting in an actuarial survival of 87 +/- 6.2%. Conclusion: The replacement of chordae tendineae with ePTFE sutures during mitral valve repair has shown good mid-term results. The implantation of the neochordae can be also performed safely using minimally invasive procedures.