Chordal rupture. II: comparison between repair and replacement.

Abstract

suMMARY During the period 1970-81, 183 patients underwent mitral valve surgery for chordal rupture. Of these, 82 (45%) patients were treated by mitral valve repair and 101 (55%) by mitral valve replacement. Mean age at surgery was 57 years. The early mortality was nine of 183 (4.9%) patients, of whom five had undergone replacement and four repair. During the follow up period (mean 3-6 years, range 0-8-12-2 years) a further 27 patients died; 23 of these had undergone mitral valve replacement and four mitral valve repair. Cerebrovascular events accounted for 35% of the deaths after mitral valve replacement and none of those after mitral valve repair. In 11 patients repair was technically unsatisfactory, and mitral valve replacement was undertaken at the same operation; a further five patients required late replacement (mean 1.4 years) for pronounced mitral regurgitation. Actuarial curves predict a six year survival of 68+5 7% (mean+ SD) for all patients after mitral valve replacement compared with 88+6*9% (mean±+SD) after repair (p<001). Actuarial survival curves favour mitral valve repair as the procedure choice for chordal rupture, and in isolated posterior cusp repair breakdown of the repair is a rare occurrence.

Comparison of Real Time Two‐Dimensional with Live/Real Time Three‐Dimensional Transesophageal Echocardiography in the Evaluation of Mitral Valve Prolapse and Chordae Rupture

“…2 Since surgery with repair of the ruptured chordae tendinae of the affected valve leaflet is the appropriate choice for operative candidates, accurate delineation of the pathology is vital for the surgeon. [3][4][5] Real time two-dimensional transthoracic echocardiography (2D TTE) and real time two-dimensional transesophageal echocardiography (2D TEE) are proven modalities for the evaluation of MV pathology, 8 but do have certain hindrances. Three-dimensional transesophageal echocardiographic (3D TEE) reconstruction has been shown to accurately delineate the correct prolapsed segment or scallop and verified by surgeons in the operating room, 9 but it also has its own set of limitations.…”

“…This procedure carries a reoperation rate of about 0.5% per year 2 . In the past, MV replacement was considered over MV repair when the anterior mitral leaflet (AML) was involved, especially if it required resection of one‐fourth or more of the anterior leaflet, due to the increased risk of failure and reoperation after repair 5 . However, surgical techniques of AML repair have advanced, beginning with triangular resection and progressing to chordal shortening, chordal transfer, or commissural annuloplasty, while occasionally even utilizing the insertion of artificial polytetrafluoroethylene neochordae 2,5–7 .…”

Assessment of the results of early and medium-term of mitral valve repairs

“…Salvador ve ark. [16] Bayazıt büzme-uçkur tekniğindeki gibi otolog perikard anuloplasti uygulanan 490 hastanın 15 yıllık izlemlerinde reoperasyonsuz yaşam oranını %93, Carpentier [15] Cosgrove, Stewart [7] Lessena [8] Galloway [9] Konstantinov [10] Duran [6] Antunes [11] Kerth [12] Oliviera [13] Orszulak [14] Çalışmamız Suri ve ark. [17] mitral onarım uyguladıkları 1.218 hastayı ortalama 11,5 yıl takip etmişler; mitral yetmezlik rekürensini %13.3, reoperasyon oranını %6,9 olarak bulmuşlardır.…”

“…Anuloplasti halkalarında anatomik yapıya uygun düzenlemeler liflet koaptasyonunu daha iyi hâle getirmiş, peroperatuar yetmezliğin transözofajiyal eko ile saptanması ve düzeltilmesi sonuçları olumlu etkilemiştir. Bu gelişmelerle birlikte, geçmiş dönemlerde uygulanan onarım tekniklerinin uzun dönem sonuçlarının da iyi olması uygun olgularda tercih edilebileceğini göstermektedir [5][6][7][8][9][10][11][12][13][14] .…”

Native and Prosthetic Valve Emergencies

“…26 Valve repair also appears to be superior to replacement for those hemodynamically unstable patients presenting with acute MR secondary to endocarditis as well. 27 Recent data have suggested that outcomes from surgery for patients presenting with mitral valve endocarditis and cardiogenic shock are reasonable, whereas the early prognosis associated with septic shock was grim.…”