Six-Year Outcomes after Non-Resective Mitral Valve Repair with Artificial Chordae Using Removable Clips

Background and aim of the study: The results were evaluated of a non-resective technique for mitral valve repair with artificial chordae implantation that allows modification of the length of the chordae as many times as necessary, and avoids inadvertent alteration of chordal length during fixation by using removable clips. Methods: After having determined the length of the artificial chordae, a removable clip was tied on the two thread ends to prevent sliding when performing the competence test. The length of the artificial chordae could be modified by opening the clip and closing it elsewhere along the chordae length. When the competence test was satisfactory, the threads were knotted on the clips. Long-term follow up was completed between January and May 2012, by echocardiography plus consultation with a cardiologist at the authors' institution. Results: A total of 47 patients underwent repair with this technique. Follow up was complete at a median of 6.0 years. There were no in-hospital deaths, but four deaths occurred during the follow up period (8.5%). The survival rate at six years was 91.5 +/- 2.1%. One patient (2.1%) had recurrent mitral regurgitation (MR) and required reoperation within two years after the initial surgery. The event-free survival rate, defined as survival free from death, reoperation or cardiovascular adverse events, was 87.2 +/- 5.2% at six years. At the time of follow up, echocardiography identified a fully competent valve or minimal MR in 45 patients (96%), mild MR in one patient (2.1%), and significant MR in one patient (2.1%). Conclusion: A satisfactory six-year outcome is reported for this method, whereby removable clips were used to determine the correct length of the artificial chordae, and for accurate tying of the knots.