Long-term outcomes of chordal replacement with ePTFE sutures to repair mitral leaflet prolapse

Abstract Objectives This study examines the durability of mitral valve (MV) repair for mitral regurgitation (MR) using chordal replacement with ePTFE sutures to correct leaflet prolapse. Methods Isolated chordal replacement was used to correct prolapse in 186 (24.9%) patients and combined with leaflet resection in 560 (75.1%). Patients were followed prospectively with periodical clinical and echocardiographic assessments for a median follow-up of 11 years (7-16 years). Results Patients’ median age was 58 years (48-67 years) and 516 (69.2%) were men. Bileaflet prolapse was present in 63% of the patients and advanced myxomatous degeneration in 32%. The number of neo-chords per repaired valve increased over time and was not associated with MV reoperation or recurrent MR. The cumulative incidence of MV reoperation with death as a competing risk was 4.2 % [95% C.I. 2.4 - 6.0] at 20 years. Multivariable analysis revealed that previous cardiac operations (HR 5.70 [95% C.I. 1.96-16.53]; p = 0.001), and isolated anterior leaflet prolapse (HR 3.92 [95% C.I. 1.10 6 -13.91]; p = 0.034) were associated with increased hazard of MV reoperation. The probability of recurrent moderate or severe MR using repeated measures regression models was 14.1 % [95% C.I.10.3-19.0] at 20 years. Variables associated with recurrent MR in multivariable regression analysis were left ventricular ejection Conclusions Chordal replacement with ePTFE sutures provides stable MV function in most patients during the first 2 decades of follow-up.