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A 25-year study of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair†.
- Source :
-
Interactive cardiovascular and thoracic surgery [Interact Cardiovasc Thorac Surg] 2015 Apr; Vol. 20 (4), pp. 463-8; discussion 468. Date of Electronic Publication: 2014 Dec 29. - Publication Year :
- 2015
-
Abstract
- Objectives: This study examines the outcome of mitral valve repair with chordal replacement using expanded polytetrafluoroethylene over the past 25 years.<br />Methods: From July 1988 to February 2013, 224 consecutive patients (mean age 57 years, 34% women) underwent mitral valve repair with chordal replacement using expanded polytetrafluoroethylene sutures at our institution. Isolated anterior leaflet prolapse was observed in 134 patients (60%), isolated posterior leaflet prolapse was observed in 13 patients (6%) and bileaflet prolapse was observed in 77 patients (34%). The number of replaced artificial chordae ranged from 2 to 12 (mean 3.7) per patient. Transthoracic echocardiography was performed pre- and postoperatively and in the follow-up period. The follow-up period ranged from 0.3 to 25.3 years (mean 7.4, median 6.2).<br />Results: There was 1 early death and 15 late deaths, of which 7 were cardiac related. The actuarial survival rates at 10 and 20 years were 92 and 81%, respectively. Thirty-three patients (15%) developed recurrent moderate or severe mitral regurgitation during the follow-up period and 30 patients (13%) required reoperation on the mitral valve. Rates of freedom from reoperation and freedom from recurrent moderate or severe mitral regurgitation were 84 and 82% at 10 years, and 74 and 59% at 20 years, respectively. Multivariate analysis revealed that the independent predictors of recurrent mitral regurgitation were mitral valve repair without annuloplasty ring and greater than mild postoperative mitral regurgitation; and the independent predictors of mitral reoperation were previous cardiac surgery and greater than mild postoperative mitral regurgitation. Histopathological analysis of the expanded polytetrafluoroethylene sutures removed during reoperation revealed complete endothelialization without calcification or microthrombi.<br />Conclusions: Our 25-year follow-up demonstrated reliable long-term outcomes of chordal replacement with expanded polytetrafluoroethylene sutures.<br /> (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Subjects :
- Adult
Aged
Chordae Tendineae physiopathology
Disease-Free Survival
Equipment Design
Female
Heart Valve Prosthesis Implantation adverse effects
Heart Valve Prosthesis Implantation mortality
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Mitral Valve physiopathology
Mitral Valve Annuloplasty adverse effects
Mitral Valve Annuloplasty mortality
Mitral Valve Insufficiency diagnosis
Mitral Valve Insufficiency mortality
Mitral Valve Insufficiency physiopathology
Mitral Valve Prolapse diagnosis
Mitral Valve Prolapse mortality
Mitral Valve Prolapse physiopathology
Postoperative Complications mortality
Postoperative Complications surgery
Proportional Hazards Models
Recurrence
Reoperation
Retrospective Studies
Risk Factors
Suture Techniques adverse effects
Suture Techniques mortality
Time Factors
Treatment Outcome
Chordae Tendineae surgery
Heart Valve Prosthesis Implantation instrumentation
Mitral Valve surgery
Mitral Valve Annuloplasty instrumentation
Mitral Valve Insufficiency surgery
Mitral Valve Prolapse surgery
Polytetrafluoroethylene
Suture Techniques instrumentation
Sutures
Subjects
Details
- Language :
- English
- ISSN :
- 1569-9285
- Volume :
- 20
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Interactive cardiovascular and thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 25547921
- Full Text :
- https://doi.org/10.1093/icvts/ivu441