REPAIR OF ANTERIOR LEAFLET PROLAPSE - CHORDAL TRANSFER IS SUPERIOR TOCHORDAL SHORTENING

Several techniques are currently used to repair anterior leaflets with elongated or ruptured chordae. To evaluate the efficacy of these tech niques, we analyzed the case histories of 108 patients operated on fro m 1989 through 1992 with degenerative mitral valve disease and prolaps e of the anterior leaflet. The mean age was 59 +/- 15 years (range 18 to 87 years) and 74 (69%) were male. Methods: Chordal shortening was p erformed in 31 (29%) and chordal transfer in 77 (71%) of the repairs. Of the transfers, 58 (75%) were from the posterior to the anterior lea flet and 16 (21%) were from the secondary to the primary position of t he anterior leaflet. Three patients had both types of transfers, Seven ty-one (66%) patients had isolated repairs and the remainder had assoc iated procedures. The degree of preoperative mitral regurgitation was 3+ or greater for 107 (99%) of the patients, mean 3.4 for shortening a nd 3.7 for transfer. Results: Four (4.0%) hospital deaths occurred, no ne after isolated repair. Follow-up of hospital survivors was 100% com plete at a mean of 4.0 years. A total of 421 patient-years of follow-u p were available for analysis. There were seven late deaths, for a 5-y ear actuarial survival of 93%. Eleven patients underwent reoperation f or recurrent mitral regurgitation, Five-year actuarial freedom from re operation was 90%-96% after chordal transfer and 74% after chordal sho rtening, p = 0.003. Independent predictors for reoperation include cho rdal shortening and preoperative New York Heart Association functional class III or IV. The mechanism of valve failure in six of seven patie nts undergoing reoperation after chordal shortening was rupture of the previously shortened chordae. Conclusions: We conclude that chordal t ransfer is superior to chordal shortening, providing a more predictabl e correction of mitral regurgitation and a lower incidence of reoperat ion. Reoperations after chordal shortening are a result of rupture of the previously shortened chordae.