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OBJECTIVE: Mitral valve repair with artificial chordae remains challenging because of accurate length adjustment of chordae and tying the knot at the intended length. Here, we describe a novel technique of artificial chordae and report the long-term results.
METHODS: From January 2006 to June 2014, 112 patients (43 females) aged 51.4 ± 14.4 years underwent mitral valve repair with artificial chordate (polytetrafluoroethylene) and C-ring mitral annuloplasty in our apartment. All patients had more than moderate MR and mitral valve prolapse due to chordal elongation and rupture. Valve lesions were posterior in 68 cases, anterior in 29 cases, and both anterior and posterior in 15 cases. The double-armed chordae was fixed at the papillary muscle head using “U” shaped suture without pledgets. The needles were passed through the free edge of the prolapsing portion (3~5 mm from the margin) twice from ventricular to atrial side (Fig.1A). Mitral annuloplasty was then performed using an appropriate C-ring mitral prosthetics. The correct chordal height adjustment was obtained by injecting saline into left ventricle (Fig.1B). After that, both needles were passed through the prolapsing scallop one more time (Fig.1A). Finally, both arms of the artificial chordae were tied and cut.
RESULTS: 2.4 ± 0.7 artificial chordaes were implanted for each patient. The average cardiopulmonary bypass time was 86.0 ± 11.6 min and average aortic crossclamp time was 62.2 ± 10.8 min. Intra-operative TEE showed no MR in 78 cases and trivial MR in 34 cases. No patient required mitral valve replacement or redo repair during the surgery. The average follow-up time was 41.5 ± 24.8 months. Follow-up TTE showed no or trivial MR in 83 patients, mild MR in 26 patients and moderate MR in 3 patients. The freedom from moderate or severe regurgitation after mitral valve repair was 95.1 ± 3.0%.
CONCLUSIONS: This novel technique of artificial chordae was simple and effective for adjusting the chordal length and tying the knot at the intended length. The long-term results were satisfactory.