Journal Article

A 17-year experience with mitral valve repair with artificial chordae in infants and children

Shinichiro Oda, Toshihide Nakano, Hideki Tatewaki, Kazuhiro Hinokiyama, Daisuke Machida and Hideaki Kado

in European Journal of Cardio-Thoracic Surgery

Published on behalf of European Association for Cardio-Thoracic Surgery

Volume 44, issue 1, pages e40-e45
Published in print July 2013 | ISSN: 1010-7940
Published online March 2013 | e-ISSN: 1873-734X | DOI: http://dx.doi.org/10.1093/ejcts/ezt183
A 17-year experience with mitral valve repair with artificial chordae in infants and children

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OBJECTIVES

We sought to examine our long-term results of mitral valve (MV) repair with expanded polytetrafluoroethylene (ePTFE) sutures and to determine the predictors for the outcome of this procedure.

METHODS

Between 1995 and 2011, MV repair with chordal reconstruction by artificial chordae was achieved in 78 patients (34 males and 44 females). Median age at repair was 1.5 years (range 3.6 months–13.4) and weight was 9.1 kg (2.5–31.4). The mean follow-up was 8.3 years. A Cox proportional hazards model was used to analyse the risk factors for a composite outcome of death, conversion to other MV repair techniques or MV replacement, reoperation on MV and recurrent mitral regurgitation (MR).

RESULTS

According to Carpentier classification, 65 (83.3%) patients were Type 2 and 13 (16.7%) were Type 3. Mitral annuloplasty was performed in all cases, except 2. During MV repair, 8 (10.3%) patients were ineffective with artificial chordae and converted to other techniques. Six (7.7%) patients underwent MV reoperation (three repairs and three replacements). Freedom from MV reoperation was 92.5 and 90.4% at 5 and 10 years, respectively. There was 1 in-hospital death. At the latest follow-up, moderate or more MR was observed in 3 (3.8%) patients. Risks for the composite outcome were low body weight at operation and Carpentier classification Type 3.

CONCLUSIONS

MV repair with artificial chordae in infants and children is safe and effective and associated with a low reoperation rate. Further investigation into the long-term durability and biological adaptation of ePTFE sutures after patient growth is mandatory.

Keywords: Mitral valve repair; Artificial chordae; Expanded polytetrafluoroethylene; Congenital heart disease; Long-term outcome

Journal Article.  3723 words.  Illustrated.

Subjects: Cardiovascular Medicine ; Cardiothoracic Surgery

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