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Ann Thorac Surg 2006;81:1526-1528
© 2006 The Society of Thoracic Surgeons

How to do it

"Adjustable" Artificial Chordal Replacement for Repair of Mitral Valve Prolapse

J. Scott Rankin, MDa,b,*, Ricardo E. Orozcoa,b, Tracey L. Rodgersa,b, David D. Alfery, MDa,b, Donald D. Glower, MDa,b

a Centennial Hospital, Vanderbilt University, Nashville, Tennessee
b Duke University Medical Center, Durham, North Carolina

Accepted for publication January 10, 2005.

* Address correspondence to Dr Rankin, 2400 Patterson St, Ste 103, Nashville, TN 37203 (Email: jsrankinmd{at}cs.com).

Achieving a stable repair of mitral valve prolapse can be difficult in complex pathologies, and a 5% to 20% late reoperation rate exists with leaflet resection and reconstruction. During an 8-year period, prolapse was managed uniformly with "adjustable" Gortex (W. L. Gore & Associates Inc, Flagstaff, AZ) artificial chordal replacement and Carpentier ring annuloplasty (Edwards Lifesciences LLC, Irvine, CA), without leaflet resection. Artificial chords were placed initially in the papillary muscles, and then after ring annuloplasty they were adjusted to optimize length to the prolapsing segment(s). Of 52 patients with prolapse, 100% were repaired successfully with artificial chords. Operative mortality was 1.9%, and 4, 6, and 8-year survivals were 87%, 81%, and 71%, respectively. Only 1 of 52 patients (1.9%) experienced late failure, and this patient was re-repaired with artificial chords. Thus, "adjustable" artificial chordal replacement facilitates uniform repair of mitral valve prolapse with a low late failure rate.




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