1019-29 Resection vs PTFE Chordal Replacement for Repair of Mitral Valve Insufficiency

Traditional management of prolapsing leaflets involves leaflet resection ± native chordal repair. Uncertainty exists as to the role of chordal replacement with PTFE sutures. We compared the outcome of repair in 108 pts, 56 (52%) with #5 PTFE chordae (C) and 52 (48%) with resection (R). Both C a R had Puig-Massana ring annuloplasties. Mean age was 61 ± 16 yrs, 53 were male (49%) and 79% of pts were NYHA III or IV. Sinus rhythm was present in 75 (69%) pts, atrial fibrillation in 25 (23%). Etiology was myxomatous: 68 (63%). rheumatic: 13 (12%) ischemic: 12 pts (11%). Other valve replacement ± CAB were performed in C 16 (29%) pts, R 27 (52%) (p = 0.0132). Clamp time was 56 ± 23 min. for C, 61 ± 28 min for R (p = NS). bypass time 78 ± 30 and 84 ± 30 min (p = NS). Mortality (30 day) was CR 1/56 (1.8%), R 3/52 (5.8%) (p = NS). Post-op, mitral regurgitation was absent/mild in 104 (96%) pts, for CR 53 (95%), R 51 (98%) (p = NS). Predischarge mitral valve gradient was for CR, 2.45 ± 1.78 mm and RT 2.73 ± 2.45 mm (p = NS). At follow-up of up to 5 years, 96% of pts were NYHA I or II. Reoperation was required in C 1/56 (2%) R 4/52 (8%). p = NS. Thus use of C produced results similar to R. C repair can be used in all pts with mobile leaflets and mitral regurgitation, especially when both anterior and posterior leaflets are involved.