Long-term Results of Modified Artificial Chordae Technique and Annuloplasty in Mitral Valvuloplasty for Mitral Leaflet Prolapse_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGZhao-lei ,  MEIJu , DINGFang-bao , MANan , YUANYuan , BAOChun-rong , TANGMin , LIUHao

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P.R.China;

Corresponding author：

MEIJu, Email: ju_mei63@126.com

Keywords：

Mitral regurgitation; Mitral valve repair; Artificial chordate; Expanded polytetrafluoroethylene

DOI：

10.7507/1007-4848.20160102

Video：

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Objective To explore the result of of modified artificial chordae technique and annuloplasty in mitral valvuloplasty for mitral leaflet prolapse. Methods We retrospectively analyzed the clinical data of 112 patients underwent mitral valve repair with artificial chordae (expanded polytetrafluoroethylene, ePTFE) and annuloplasty in our hospital from January 2006 through June 2014.There were 69 males and 43 females at age of 5-73 (51.4±14.4) years.The double-armed ePTFE chordae was fixed at papillary muscle head using U shaped suture without pledget and passed through the prolapsing portion of leaflet twice.Then, annuloplasty was performed and correct chordal length was adjusted.After that, the chordae was passed through prolapsing scallop one more time and tied. Results Average of 2.4±0.7 (range from 1 to 3) ePTFE artificial chordaes were implanted in each patient.Intra-operative transthoracic echocardiography showed no mitral regurgitation (MR) in 78 patients and tricuspid regurgitation in 34 patients.At discharge, no MR was in 72 patients, trivial MR in 39 patients, and mild MR in 1 patient.At end of follow-up of 41.5±24.8 months, moderate MR was in 3 patients.The freedom from moderate or severe regurgitation at 5 years after mitral valve repair was 95.1%±3.0%. Conclusion This modified artificial chordae technique and annuloplasty are safe, simple, and effective in mitral valvuloplasty for mitral leaflet prolapsed.And the early and long-term results are satisfactory.

Citation： JIANGZhao-lei, MEIJu, DINGFang-bao, MANan, YUANYuan, BAOChun-rong, TANGMin, LIUHao. Long-term Results of Modified Artificial Chordae Technique and Annuloplasty in Mitral Valvuloplasty for Mitral Leaflet Prolapse. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(5): 430-433. doi: 10.7507/1007-4848.20160102 Copy

1.	Ibrahim M, Rao C, Savvopoulou M, et al. Outcomes of mitral valve repair using artificial chordae. Eur J Cardiothorac Surg, 2014, 45(4): 593-601.
2.	Bortolotti U, Milano AD, Frater RW. Mitral valve repair with artificial chordae: a review of its history, technical details, long-term results, and pathology. Ann Thorac Surg, 2012, 93(2): 684-691.
3.	Fattouch K, Bianco G, Sbraga F, et al. Simple, safe and easy technique to ensure the correct length of artificial chordae in mitral valve repair. Ann Thorac Surg, 2007, 83(5): 1902-1903.
4.	Bizzarri F, Tudisco A, Ricci M, et al. Different ways to repair the mitral valve with artificial chordae: a systematic review. J Cardiothorac Surg, 2010, 5: 22.
5.	Lange R, Guenther T, Noebauer C, et al. Chordal replacement versus quadrangular resection for repair of isolated posterior mitral leaflet prolapse. Ann Thorac Surg, 2010, 89(4): 1163-1170.
6.	Gillinov AM, Cosgrove DM. Mitral valve repair for degenerative disease. J Heart Valve Dis, 2002, 11(Suppl 1): S15-S20.
7.	Morimoto H, Tsuchiya K, Nakajima M, et al. Mitral valve repair for anterior leaflet prolapse: surgical techniques review and 16-year follow-up results. J Card Surg, 2008, 23(5): 426-430.
8.	Aubert S, Barreda T, Acar C, Leprince P, et al. Mitral valve repair for commissural prolapse: surgical techniques and long term results. Eur J Cardiothorac Surg, 2005, 28(3): 443-447.
9.	David TE. Replacement of chordae tendineae with expanded polytetrafluoroethylene sutures. J Card Surg, 1989, 4(4): 286-290.
10.	David TE, Bos J, Rakowski H. Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg, 101(3): 495-501.
11.	David TE. Artificial chordae. Semin Thorac Cardiovasc Surg, 2004, 16(2): 161-168.
12.	Kasegawa H, Shimokawa T, Shibazaki I, et al. Mitral valve repair for anterior leaflet prolapse with expanded polytetrafluoroethylene sutures. Ann Thorac Surg, 2006, 81(5): 1625-1631.
13.	Cagli K. A simple method of making artificial chordal loops for mitral valve repair. Ann Thorac Surg, 2010, 89(2): e12-e14.
14.	Chang JP, Kao CL. Slit stent technique for ensuring the correct length of artificial chordae in mitral repair. J Card Surg, 2011, 26(3): 259-260.
15.	Mandegar MH, Yousefnia MA, Roshanali F. Preoperative determination of artificial chordae length. Ann Thorac Surg, 2007, 84(2): 680-682.
16.	Moorjani N, Viola N, Janusauskas V, et al. Adjusting the length of artificial polytetrafluoroethylene chordae in mitral valve repair by a single loop technique. J Thorac Cardiovasc Surg, 2009, 138(6): 1441-1442.
17.	von Oppell UO, Mohr FW. Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops. Ann Thorac Surg, 2000, 70(6): 2166-2168.
18.	Kudo M, Yozu R, Kokaji K, et al. Feasibility of mitral valve repair using the loop technique. Ann Thorac Cardiovasc Surg, 2007, 13(1): 21-26.
19.	Soga Y, Nishimura K, Ikeda T, et al. Chordal-sparing mitral valve replacement using artificial chordae tendineae for rheumatic mitral stenosis: experience of the “oblique” method. Artif Organs, 2002, 26(9): 802-805.
20.	Salvador L, Mirone S, Bianchini R, et al. A 20-year experience with mitral valve repair with artificial chordae in 608 patients. J Thorac Cardiovasc Surg, 2008, 135(6): 1280-1287.

1. Ibrahim M, Rao C, Savvopoulou M, et al. Outcomes of mitral valve repair using artificial chordae. Eur J Cardiothorac Surg, 2014, 45(4): 593-601.
2. Bortolotti U, Milano AD, Frater RW. Mitral valve repair with artificial chordae: a review of its history, technical details, long-term results, and pathology. Ann Thorac Surg, 2012, 93(2): 684-691.
3. Fattouch K, Bianco G, Sbraga F, et al. Simple, safe and easy technique to ensure the correct length of artificial chordae in mitral valve repair. Ann Thorac Surg, 2007, 83(5): 1902-1903.
4. Bizzarri F, Tudisco A, Ricci M, et al. Different ways to repair the mitral valve with artificial chordae: a systematic review. J Cardiothorac Surg, 2010, 5: 22.
5. Lange R, Guenther T, Noebauer C, et al. Chordal replacement versus quadrangular resection for repair of isolated posterior mitral leaflet prolapse. Ann Thorac Surg, 2010, 89(4): 1163-1170.
6. Gillinov AM, Cosgrove DM. Mitral valve repair for degenerative disease. J Heart Valve Dis, 2002, 11(Suppl 1): S15-S20.
7. Morimoto H, Tsuchiya K, Nakajima M, et al. Mitral valve repair for anterior leaflet prolapse: surgical techniques review and 16-year follow-up results. J Card Surg, 2008, 23(5): 426-430.
8. Aubert S, Barreda T, Acar C, Leprince P, et al. Mitral valve repair for commissural prolapse: surgical techniques and long term results. Eur J Cardiothorac Surg, 2005, 28(3): 443-447.
9. David TE. Replacement of chordae tendineae with expanded polytetrafluoroethylene sutures. J Card Surg, 1989, 4(4): 286-290.
10. David TE, Bos J, Rakowski H. Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg, 101(3): 495-501.
11. David TE. Artificial chordae. Semin Thorac Cardiovasc Surg, 2004, 16(2): 161-168.
12. Kasegawa H, Shimokawa T, Shibazaki I, et al. Mitral valve repair for anterior leaflet prolapse with expanded polytetrafluoroethylene sutures. Ann Thorac Surg, 2006, 81(5): 1625-1631.
13. Cagli K. A simple method of making artificial chordal loops for mitral valve repair. Ann Thorac Surg, 2010, 89(2): e12-e14.
14. Chang JP, Kao CL. Slit stent technique for ensuring the correct length of artificial chordae in mitral repair. J Card Surg, 2011, 26(3): 259-260.
15. Mandegar MH, Yousefnia MA, Roshanali F. Preoperative determination of artificial chordae length. Ann Thorac Surg, 2007, 84(2): 680-682.
16. Moorjani N, Viola N, Janusauskas V, et al. Adjusting the length of artificial polytetrafluoroethylene chordae in mitral valve repair by a single loop technique. J Thorac Cardiovasc Surg, 2009, 138(6): 1441-1442.
17. von Oppell UO, Mohr FW. Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops. Ann Thorac Surg, 2000, 70(6): 2166-2168.
18. Kudo M, Yozu R, Kokaji K, et al. Feasibility of mitral valve repair using the loop technique. Ann Thorac Cardiovasc Surg, 2007, 13(1): 21-26.
19. Soga Y, Nishimura K, Ikeda T, et al. Chordal-sparing mitral valve replacement using artificial chordae tendineae for rheumatic mitral stenosis: experience of the “oblique” method. Artif Organs, 2002, 26(9): 802-805.
20. Salvador L, Mirone S, Bianchini R, et al. A 20-year experience with mitral valve repair with artificial chordae in 608 patients. J Thorac Cardiovasc Surg, 2008, 135(6): 1280-1287.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Long-term Results of Modified Artificial Chordae Technique and Annuloplasty in Mitral Valvuloplasty for Mitral Leaflet Prolapse

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