Artificial chordae.

One hundred and eighty-seven patients had mitral valve repair and 28 mitral valve replacement using 5-0 expanded polytetrafluoroethylene (e-PTFE). A mean of 6.7 (range 2-24) artificial chordae were utilized in each patient, associated with an autologous pericardium reinforced suture annuloplasty in most cases. Six patients required mitral valve replacement during the same operation, and one after 48 hours for unsatisfactory operative result. There was one operative death due to respiratory insufficiency. NO early valve-related complications were reported. At a mean follow up of 35.6 months (range 1-99 months), two more patients died because of cardiomyopathy and multi-organ failure, respectively, while only one patient experienced a TIA, returning to sinus rhythm two months after operation. Three patients required reoperation for rupture of natural chordae, traditionally shortened at operation in one case; for technical error in tying the artificial chordae in the second, and for progression of the degenerative disease in the third. At reoperation the artificial chordae appeared partially covered by a fibrous sheath, without any sign of thrombosis or calcification. Transesophageal echocardiography revealed a satisfactory long term result in 97% of the cases, while four patients showed a recurrence of mild mitral regurgitation, probably due to the progression of rheumatic valve pathology. Ninety-five percent of the patients are in NYHA class I. This surgical technique appears to be reproducible and reliable, improving the results of mitral valve repair, increasing the number of valves repaired, and optimizing left ventricular function in the case of mitral valve replacement with unavoidable removal of the entire subvalvular apparatus.