Chordal transposition for anterior mitral prolapse: early and long-term results

Abstract

OBJECTIVE: Chordal transposition was advocated for correction ofanterior mitral prolapse. We have evaluated the early and late results ofthis technique in different anatomical presentations. METHODS: From 1986 to1995, 185 mitral valve repairs were carried out for pure mitralregurgitation due to a degenerative disease. Eighty-nine patients hadeither an anterior prolapse (39) or prolapse of both leaflets (50) atinitial presentation and underwent chordal transposition from the muralleaflet to the anterior leaflet. The corrective procedure was completed bypolytetrafluoroethylene or pericardial posterior annuloplasty. Twentypatients presented a complex pathology and 26 had chordal elongation ofmural leaflet. Annular calcifications were found in 9 patients. Sevenpatients required shortening of transposed chordae and two patients theadditional shortening of an anterior chorda. RESULTS: Operative mortalitywas 3.3% and follow-up was 95% complete (average 41 months). There werefive postreconstruction valve replacements (two earlier and three later)for a probability of freedom from late reoperation or 3+ mitralregurgitation of 88.6 +/- 4.8% at 5 years. Of the patients 79% presented noor trivial residual MR, 17% moderate MR and 4% severe MR. The presence of acomplex pathology or posterior chordal elongation did not influence theentity of postoperative residual regurgitation. On the contrary, thepatients with annular calcifications had a residual regurgitation/leftatrium area ratio greater than patients without annular calcification (15.8+/- 11.5% vs. 6.1 + 9.9%; P = 0.009). CONCLUSIONS: Chordal transposition isan effective and easily carried out technique for the correction ofanterior mitral prolapse. The presence of a complex pathology or posteriorchordal elongation do not rule out the procedure. The absence of annularcalcification is important in order to obtain a satisfactorycorrection.