Midterm Results of Mitral Valve Repair by the New Chordae Formation Technique

Lee, Jae Won; Lim, Han Jung; Jung, Sung Ho; Kim, Kun Il; Choo, Suk Jung; Song, Hyun; Song, Meung Gun

Abstract

BACKGROUND: The optimal treatment for mitral regurgitation from leaflet prolapse or multiple leaflet pathology is not yet established. Recently, new chordae formation(NC) with olytetra-fluoroethylene(PTFE) has become increasingly popular. The aims of the current study was to see the effects of new chordae formation on mitral alvuloplasty. MATERIAL AND METHOD: From January 1994 to december 1999 322 patients receiving itral valvuloplasty were divided into two groups in which 144 patients(Group I) received NC and 178 patients(group II) received mitral valvuloplasty without NC. Echocardiograms were performed in the immediate postoperative period, at 6 months and 1 year after surgery and annually thereafter. RESULT: Mitral valvuloplasty was performed for mitral regurgitation in 95%(322/ 337) of the patients and the mean followup period was 27+/-20.6 months of which follow-up was complete for 95.4%(306/ 322). The degree of mitral regurgitation in both groups I and II improved from 3.8+/-0.4 to 1.3+/-0.9 and 3.6+/-0.3 to 1.1+/-0.7, respectively. There was also no significant difference in the mean mitral area or transvavular pressure gradient across the mitral valve. The overall early and late mortality rates were 0.9%(3) and 1.2%(4), also showing no significant difference between the two groups. The late survival rate(97.8+/-1.6 vs 97.7+/-1.6%), freedom from structural degeneration 93.7+/-3.6 vs 90.7+/-3.4%) freedom from reoperation(99.3+/-0.7 vs 96.6+/-1.8%), freedom from thromboembolism, freedom infective endocarditis, and valve related complications showed no significant difference between the two groups.
CONCLUSION
Mitral valvuloplasty with NC not only resulted in an increase in the volume of mitral reconstruction(r=0.98, p<0.01) but enhanced urability and stability comparable to currently established methods. Mitral valvuloplasty with NC was especially effective in the treatment of pan valvular pathology, commissural lesions and multiple leaflet pathology which would otherwise have been difficult to treat with current methods.