Repair of anterior leaflet mitral valve prolapse: Chordal replacement versus chordal shortening

Background. To determine the optimal method of repair for severe, segmental anterior leaflet prolapse, we analyzed outcome of 121 patients who underwe nt chordal shortening (n = 46) and chordal replacement (n = 75) from 1988 t o 1996. Methods. Chordae were replaced with expanded polytetrafluoroethylene suture s. Patients had an annuloplasty with either chordal replacement or shorteni ng. Follow-up was 100% complete (mean, 3.7 years). Results. Mean age was 62.1 years, 86 were men, and 60 patients had isolated valve repair. There was one hospital death and 14 late deaths for a 5-year actuarial survival of 86.4% +/- 4.5%. Sixteen patients underwent reoperati on, 5 in the replacement group and 11 in the shortening group. Mechanism of valve failure in the replacement group was native chordae rupture (n = 4) and neochordae dehiscence (n = 1). With chordal shortening, repair failure was attributed to rupture of shortened chordae (n = 8), leaflet prolapse wi th and without annuloplasty ring dehiscence (n = 2), and native chordae elo ngation (n = 1). Risk of reoperation because of repair failure at 3.5 years was 1.4% in the chordal replacement group and 14.8% in the chordal shorten ing group (p = 0.02). Conclusions. Chordal replacement is superior to chordal shortening, providi ng a predictable method for correction of mitral regurgitation with a low i ncidence of reoperation. (C) 2000 by The Society of Thoracic Surgeons.