Use Of Novel PTFE-Neo-chordae For Minimally Invasive Mitral Valve Repair
Daniel Hoefer, Herbert Hangler, Christoph Krapf, Nikos Bonaros, Johannes Holfeld, Cenk Özpeker, Michael Grimm, Ludwig Mueller.
Cardiac Surgery Innsbruck, Innsbruck, Austria.
Background: The use of neo-chordae for mitral valve (MV) repair is a common technique, either single chordae or loops. The established material is ePTFE. We report on the successful use of novel non expanded PTFE material as an available alternative. Methods: From November 2016 until December 2018 PTFE loops were used in 123 patients. The cohort consisted of total endoscopic procedures (n=94; 76.4%) and partial upper sternotomy (PS) access (n=29; 23.6%). PS was applied in patients with contraindications to endoscopic procedure such as severe annular calcification or additional surgery like aortic valve replacement or bypass grafting. Results: Mean age was 62 years, 80 (65%) were male, 43 (35%) female. The most common etiology was degenerative MV disease, in 23% both leaflets were affected. In all patients irrespective of the surgical approach MV repair was performed using different numbers of neo-chordae in adjunct to other measures. Mean bypass time was 187 minutes, mean aortic cross clamp time was 110 minutes. Repair was successful in all patients, at discharge 117 (95%) patients showed residual MV insufficiency lower than grade 1. All patients were discharged alive, despite rare severe complications (revision for bleeding: n=2; need for perioperative ECMO: n=2; conversion to sternotomy: n=2). So far only one patient had to be re-operated for repair failure. Conclusions: The use of non expanded PTFE neo-chordae is safe and provides the same excellent results as ePTFE materials. Long term results are pending, mid-term results are satisfying. Besides representing a viable alternative per se an advantage of the novel material is the less smooth surface allowing for less knots.
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