Gore-tex chordoplasty in degenerative mitral valve repair.

Mitral valve repair with Gore-Tex (W.L. Gore & Assoc, Inc, Flagstaff, AZ) neochordae is of increasing interest. In 2000, the loop technique using premeasured Gore-Tex neochordae was introduced by our group. Herein, we report our experience with this technique in minimally invasive mitral valve repair (MVR) for degenerative disease. Between 1999 and 2006, 468 patients (328 men and 140 women) underwent elective MVR using neochordae at our institution. The mean age of the patients was 58 +/- 12.3 years. All patients had significant mitral valve regurgitation, and the mean severity was 3.5 +/- 0.6. Prolapse of the posterior leaflet was diagnosed in 393 patients (84%), and prolapse of the anterior leaflet was diagnosed in 250 patients (53.4%). Mean left ventricular function was 64.8 +/- 12.3%. All patients were operated on with the minimally invasive approach via a right lateral mini-thoracotomy, femoral cannulation for cardiopulmonary bypass, and the transthoracic direct clamp technique. Mean duration of cardiopulmonary bypass was 136 +/- 40 minutes, and mean aortic clamp time was 87 +/- 31 minutes. Gore-Tex neochordae were used in 149 patients (32%) on both leaflets, in 224 patients (47.7%) on the posterior leaflet only, and in 95 patients (20.3%) on the anterior leaflet only. A mean number of 2.7 +/- 1 loops at a mean length of 21 +/- 3.3 mm were used on the A2 segment. On the P2 segment, a mean number of 3.2 +/- 1 loops at a mean length of 14.3 +/- 3.1 mm were applied. The intraoperative course was uneventful in all patients. Early reoperation for bleeding had to be performed in 18 patients (3.9%). Mean duration of hospital stay was 11.9 +/- 13 days. The 30-day mortality rate was 1.5% (7 patients), and 1-year mortality rate was 2.6% (12 patients). MVR with neochordae and the loop technique is an easy and effective treatment for degenerative mitral valve disease. The procedure is reliable and reproducible, leading to low morbidity and mortality. Thus, use of Gore-Tex neochordae has become the standard technique for MVR at our institution.