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

Objectives: This study examines the durability of mitral valve (MV) repair for mitral regurgitation using chordal replacement with expanded polytetrafluoroethylene 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 (range, 7-16 years). Results: Patients' median age was 58 years (range, 48-67 years) and 516 (69.2%) were men. Bileaflet prolapse was present in 63% of patients and advanced myxomatous degeneration was present in 32%. The number of neochords per repaired valve increased over time and was not associated with MV reoperation or recurrent mitral regurgitation. The cumulative incidence of MV reoperation with death as a competing risk was 4.2% (95% confidence interval [CI], 2.4-6.0) at 20 years. Multivariable analysis revealed that previous cardiac operations (hazard ratio, 5.70; 95% CI, 1.96-16.53; P =.001), and isolated anterior leaflet prolapse (hazard ratio, 3.92; 95% CI, 1.106-13.91; P =.034) were associated with increased hazard of MV reoperation. The probability of recurrent moderate or severe mitral regurgitation using repeated measures regression models was 14.1% (95% CI, 10.3-19.0) at 20 years. Variables associated with recurrent MR in multivariable regression analysis were left ventricular ejection <40% (hazard ratio, 3.57; 95% CI, 1.37-9.32; P =.009) and preoperative complete heart block (hazard ratio, 5.90; 95% CI, 2.47-14.09; P <.001). Conclusions: Chordal replacement with expanded polytetrafluoroethylene sutures provides stable MV function in most patients during the first 2 decades of follow-up.