Artificial mitral valve chordae: experimental and clinical experience

Failure of mitral valve reconstructive procedures often may be ascribed to severe or progressive alterations of subvalvar apparatus. Expanded polytetrafluoroethylene sutures were used to replace anterior leaflet mitral valve chordae in 8 animals (hypertensive dogs and growing sheep). After the positive results obtained during a 13-month follow-up, 5-0 sutures of the same material were introduced in clinical practice to replace mitral valve chordae. Twelve patients had two to six anterior leaflet chordae replaced for degenerative or rheumatic disease. In 3 patients, the intraoperative result was not acceptable and a prosthetic valve was inserted during the same operation. One case of late failure has been recorded so far (18 months after the procedure), owing to rupture of a natural chorda shortened at operation. Since that event, we have implanted supportive artificial chordae in case of diffuse alteration of natural chordae. The remaining patients show satisfactory hemodynamic results, and no valve-related events have been recognized up to 30 months after operation. We suggest use of 5-0 polytetrafluoroethylene sutures in replacing anterior leaflet chordae in degenerative, rheumatic, and congenital mitral valve diseases.