Polytetrafluoroethylene neochordae is noninferior to leaflet resection in repair of isolated posterior mitral leaflet prolapse: a multicentre study

Abstract

OBJECTIVES: Resection techniques are the established method for posterior mitral valve leaflet repair in degenerative mitral valve disease. However, implantation of expanded polytetrafluoroethylene (ePTFE) neochordae is gaining acceptance. The aim of this study was to compare the durability and clinical outcome following mitral valve repair using ePTFE neochordae or leaflet resection. METHODS: A retrospective study was conducted of 224 patients who had undergone isolated mitral valve repair for degenerative posterior mitral leaflet prolapse from 1998 to 2012 at two cardiothoracic centres, one in Sweden and one in Denmark. Follow-up was performed in February 2013 and was 100% complete for survival (1184 patient-years; mean 5.9 ± 3.9 years). Event rates were estimated with the Kaplan-Meier method. RESULTS: The 30-day mortality rate was 0.5%. Repair was successful in 215 patients (96.0%). Leaflet resection was performed in 146 (72.6%), whereas 55 (27.4%) underwent ePTFE neochordae repair. All patients received an annuloplasty with a mean size of 33 ± 4 mm in the ePTFE group and 31 ± 3 mm in the resection group (P = 0.001). The 5-year survival rate was 98.2 ± 1.8% in the ePTFE group and 93.9 ± 2.1% in the resection group (P = 0.67). At 5 years, the rate of freedom from recurrent moderate or severe mitral regurgitation was 91.9 ± 5.5% in the ePTFE group and 95.8 ± 2.1% in the resection group (P = 0.20), and the rate of freedom from all-cause reoperation was 100% in the ePTFE group and 97.9 ± 1.2% in the resection group (P = 0.36). CONCLUSIONS: ePTFE neochordae is noninferior to resection repair for posterior mitral leaflet prolapse. Both techniques have comparable early and mid-term postoperative outcomes with low mortality, and a low incidence of reoperation and recurrent mitral regurgitation.