Ten-year experience of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair

Background-Mitral valve repair is the procedure of choice to correct mitral regurgitation (MR). Although chordal replacement with expanded polytetrafl uoroethylene (ePTFE) has been widely accepted to repair anterior mitral pro lapse and other difficult situations, the long-term results of the repair a nd the fate of ePTFE have not been delineated. Methods and Results-From July 1988 to April 1999, 74 patients (49 males, 25 females) aged 17 to 77 years (mean age 55.3+/-14.8 years) underwent mitral valve repair with chordal replacement with ePTFE. The follow-up period was from 6 months to 11.3 years (mean 4.6+/-3.2 years). The causes of MR were degenerative in 65 patients (88%) and infective in 9 (12%). Three patients had active infective endocarditis. Valve lesions were anterior in 35 patien ts, posterior in 10, and both anterior and posterior in 29. Various procedu res for plasty of leaflets were necessary in 37 patients (50%). Atrial fibr illation was associated in 38 patients (51%), and the maze procedure has be en performed in a selected group of 30 patients (41%) since July 1992. Ther e was 1 in-hospital death (1.4%) and 3 late cardiac deaths (4.1%). More tha n moderate MR developed in 12 patients (17%) during the follow-up period. T hree of these patients required early reoperation within 1 year due to hemo lysis. Two patients underwent mitral valve replacement at 6 and 8 years aft er repair, respectively. The actuarial reoperation-free rates at 5 and 10 y ears were 94.3+/-2.8% and 81.7+/-9.1%, respectively. Sinus rhythm was resto red in 21 patients (70%) with the maze procedure, There was only 1 thromboe mbolic episode (0.3%/patient-y) in a patient with atrial fibrillation who d id not undergo the maze procedure. Event-free survival rates as assessed by the freedom from cardiac death, thromboembolism, reoperation, and anticoag ulation-related hemorrhage at 5 and 10 years were 91.3+/-3.4% and 71.6+/-9. 7%, respectively. There was no relationship between recurrent MR and the ch ange of ePTFE. Structural analysis of the ePTFE resected during reoperation revealed no calcification and showed remaining flexibility and pliability. Protein infiltration was observed in the ePTFE, and collagenous proliferat ion was recognized at the site of fixation to the valve leaflet and the pap illary muscle. The surface of the ePTFE was completely endothelialized, whi ch may induce antithrombogenicity. Conclusions-The long-term durability and biological adaptation of ePTFE as artificial chordae for mitral valve repair of MR were proved for >10 years.