Long-term outcomes of artificial chordal replacement with tourniquet technique in mitral valve repair: A single-center experience of 700 cases

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 148; no. 5; pp. 2033 - 2038.e1
• Main Authors: Tabata, Minoru, MD, MPH, Kasegawa, Hitoshi, MD, Fukui, Toshihiro, MD, Shimizu, Atsushi, MD, Sato, Yasunori, PhD, Takanashi, Shuichiro, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014
• Subjects: Adult; Age Factors; Aged; Cardiothoracic Surgery; Chordae Tendineae - physiopathology; Chordae Tendineae - surgery; Disease-Free Survival; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Annuloplasty - adverse effects; Mitral Valve Annuloplasty - methods; Mitral Valve Annuloplasty - mortality; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Mitral Valve Prolapse - diagnosis; Mitral Valve Prolapse - mortality; Mitral Valve Prolapse - physiopathology; Mitral Valve Prolapse - surgery; Recurrence; Reoperation; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; Tourniquets; Treatment Outcome; 35; TTE; MR; mitral regurgitation; CI; hazard ratio; transthoracic echocardiography; confidence interval; expanded polytetrafluoroethylene; HR; ePTFE
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.03.045

Objective Artificial chordal replacement has been shown to be effective and durable, with numerous techniques reported. However, the outcomes of each technique have remained poorly defined. We report the long-term outcomes of the tourniquet technique. Methods We reviewed the data from 700 patients who had undergone mitral valve repair with the tourniquet technique from 1992 to 2010. We analyzed the operative outcomes, long-term survival rate, freedom from reoperation, and freedom from recurrent moderate or severe mitral regurgitation (MR). We also performed Cox regression analysis to explore the predictors of recurrent MR after mitral valve repair using the tourniquet technique. Results The mean age was 54.7 ± 14.9 years; 212 patients (30.3%) had anterior leaflet prolapse, 142 (20.3%) had posterior leaflet prolapse, and 346 (49.4%) had bileaflet prolapse. Operative mortality was 1.3%. In 26 cases (3.7%), mitral valve repair was unsuccessful and was converted to replacement. Of those successfully repaired, the 12-year survival rate, freedom from mitral reoperation, freedom from recurrent moderate or severe MR, and freedom from recurrent leaflet prolapse was 85.9%, 88.7%, 72.3%, and 89.0%, respectively. The significant predictors of recurrent MR were anterior leaflet prolapse, age, New York Heart Association class III or IV, left ventricular end-systolic dimension, no annuloplasty ring or band, and postoperative residual mild or greater MR. Conclusions The tourniquet technique is a simple and effective method to repair leaflet prolapse, with a low incidence of recurrent prolapse. The incidence of recurrent MR was high in the anterior leaflet prolapse group. Age, no annuloplasty ring or band, and residual MR were strong predictors of recurrent MR.