Premolded Bovine Pericardial Chords for Replacement of Ruptured or Elongated Chordae Tendineae
Background: The aim of this study was to assess by Doppler echocardiography (ECO) the functioning of the mitral valve apparatus in patients who have undergone implantation of standardized bovine pericardium chordae (SBPC) for replacement of ruptured or elongated chordae tendineae with significant thinning.
Methods: SBPC were implanted in 31 patients who had mitral insufficiency due to rupture of chordae tendinae or elongated chordae with significant thinning. Patient ages ranged from 19 to 85 years (mean of 58 years). The most frequent cause of mitral insufficiency was fibroelastic degeneration in 25 patients (80.6%). The SBPC were fashioned as a set, joined at their extremities by 2 polyester-reinforced rods forming a monobloc. The SBPC were 2-mm wide and were positioned parallel to one another at a distance of 3 mm. Each set of SBPC had a corresponding measurer, and their length ranged from 20 to 35 mm. In 21 patients (67.7%) the SBPC were implanted in the posterior leaflet and in 10 patients (32.3%) in the anterior leaflet (in 2 patients concurrently in the anterior and posterior leaflets). All patients were assessed by ECO postoperatively, with a 20-month mean follow-up time (range 6-45 months).
Results: One patient (3.2%) died of pulmonary embolism during the early postoperative period. Postoperative ECO showed absence of mitral regurgitation in 17 patients (54.8%), mild regurgitation in 9 (29.0%), and mild-to-moderate regurgitation in 4 (12.9%). Opening and mobility of the mitral valve were normal in the 30 surviving patients.
Conclusion: The ECO revealed good functionality of the mitral valve apparatus with appropriate leaflet coaptation in patients who had undergone implantation of SBPC for replacement of ruptured or elongated and thinned chordae. A longer follow-up is required to assess absence of calcification and/or degeneration of the SBPC.
Akins CW, Hilgenberg AD, Buckley MJ, et al. 1994. Mitral valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation. Ann Thorac Surg 58:668-75.nAlvarez JM, Deal CW, Loveridge K, et al. 1996. Repairing the degenerative mitral valve: ten- to fifteen-year follow-up. J Thorac Cardiovasc Surg 112:238-47.nBraile DM, Ardito RV, Pinto GH, et al. 1990. Plástica mitral. Rev Bras Cir Cardiovasc 5:86-98.nBraile DM, Bilaqui A, Ardito RV, et al. 1983. Enlargement of the aortic root with a bovine pericardial patch preserved in glutaraldehyde [in Portuguese]. Arq Bras Cardiol 41:289-96.nCarabello BA. 1988. Mitral regurgitation: basic pathophysiologic principles. Mod Concepts Cardiovasc Dis 57:53-8.nCarpentier A, Relland J, Deloche A, et al. 1978. Conservative management of the prolapsed mitral valve. Ann Thorac Surg 26:294-302.nDang NC, Stewart AS, Kay J, et al. 2005. Simplified placement of multiple artificial mitral valve chords. Heart Surg Forum 8:E129-31.nDavid TE, Bos J, Rakowski H. 1991. Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg 101:495-501.nDe Vega NG, De Rábago G, Castillón L, Moreno T, Azpitarte J. 1973. A new tricuspid repair. Short-term clinical results in 23 cases. J Cardiovasc Surg (Torino) Spec No:384-6.nFalk V, Seeburger J, Czesla M, et al. 2008. How does the use of polytetrafluorethylene neochordae for posterior mitral valve prolapse (loop technique) compare with leaflet resection? A prospective randomized trial. J Thorac Cardiovascular Surg 136:1205.nFrater RW, Gabbay S, Shore D, Factor S, Strom J. 1983. Reproducible replacement of elongated or ruptured mitral valve chordae. Ann Thorac Surg 35:14-28.nGomes OM, Pitchon M, Barros MVL, Caetano MC, Oliveira NA, Gomes ES. 1990. Utilização de cordas tendíneas de pericárdio bovino em cirurgia da valva mitral. Coração 2:20-2.nGregori F, Silva SS, Hayashi SS, Aquino W, Cordeiro C, Silva LR. 1994. Mitral valvuloplasty with a new prosthetic ring. Analysis of the first 105 cases. Eur J Cardiothorac Surg 8:168-72.nGregori F Jr, Cordeiro CO, Croti UA, Hayashi SS, da Silva SS, Gregori TE. 1999. Partial tricuspid valve transfer for repair of mitral insufficiency due to ruptured chordae tendineae. Ann Thorac Surg 68:1686-91.nGregory F Jr, Takeda R, Silva S, Façanha L, Meier MA. 1988. A new technique for repair of mitral insufficiency caused by ruptured chordae of the anterior leaflet. J Thorac Cardiovasc Surg 96:765-8.nKay JH, Zubiate P, Mendez MA, Vanstrom N, Yokoyama T. 1978. Mitral valve repair for significant mitral insufficiency. Am Heart J 96:253-62.nKobayashi J, Sasako Y, Bando K, Minatoya K, Niwaya K, Kitamura S. 2000. Ten-year experience of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair. Circulation 102(Suppl 3):III30-4.nLillehei CW, Gott VL, DeWall RA, Varco RL. 1958. The surgical treatment of stenotic or regurgitant lesions of the mitral and aortic valves by direct vision utilizing a pump-oxygenator. J Thorac Surg 35:154-91.nPearson AC, St Vrain J, Mrosek D, Labovitz AJ. 1990. Color Doppler echocardiographic evaluation of patients with a flail mitral leaflet. J Am Coll Cardiol 16:232-9.nRushmer RF. 1956. Initial phase of ventricular systole: asynchronous contraction. Am J Physiol 184:188-94.nSarris GE, Cahill PD, Hansen DE, Derby GC, Miller DC. 1988. Restoration of left ventricular systolic performance after reattachment of the mitral chordae tendineae. The importance of valvular-ventricular interaction. J Thorac Cardiovasc Surg 95:969-79.nShuhaiber J, Anderson RJ. 2007. Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J Cardiothorac Surg 31:267-75.n