Invited Commentary

Abstract

Ischemic mitral regurgitation (MR) is a serious clinical problem in coronary artery disease and it is associated with poor long-term outcomes. Mitral valve repair has been reported to be better than mitral valve replacement regarding early mortality and late outcomes. Lateral replacement of the papillary muscle with the enlarged left ventricle caused tethering of the chordae, and resulted in restricted systolic motion of the mitral leaflet. Undersized ring annuloplasty has been the first choice for reduction of the dilated mitral annulus. However, because the incidence of recurrent MR was greater than 30%, a more sophisticated approach to ischemic MR is necessary. Mitral leaflet augmentation is one of the options to repair tethered mitral leaflet, besides papillary muscle approximation, secondary chordal cutting, and surgical relocation of the papillary muscle. The authors [1Ito T. Maekawa A. Yamana K. Yoshizumi T. Sunada M. Use of an expanded polytetrafluoroethylene patch as an artificial leaflet in mitral valve plasty: an early experience.Ann Thorac Surg. 2010; 89: 1620-1624Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar] reported anterior mitral leaflet augmentation with the polytetrafluoroethylene (PTFE) patch to increase coaptation zone against posterior leaflet. This procedure was similar to a previously used technique, which was leaflet augmentation with autologous or xenopericardium for functional MR or rheumatic MR. The fate of the pericardium has been shrinkage or calcification with time. Redo surgery is sometimes the situation after coronary artery bypass grafting for the treatment of ischemic MR. As autologous pericardium is difficult or impossible to harvest during a redo situation, the commercially available PTFE patch must be useful. We have used expanded PTFE sutures for chordal replacement in degenerative mitral regurgitation for 20 years [2Kobayashi J. Sasako Y. Bando K. et al.Ten-year experience of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair.Circulation. 2000; 102: III-30-III-34Crossref Google Scholar]. The sutures became completely endothelialized with anti-thrombotic characteristics. Although the Gore-Tex sutures (Ethicon, Somerville, NJ) were thicker than the original material with absorption of protein from the serum with time, the CV-4 sutures have been flexibly working even 15 years after the operation in all cases. As the authors [1Ito T. Maekawa A. Yamana K. Yoshizumi T. Sunada M. Use of an expanded polytetrafluoroethylene patch as an artificial leaflet in mitral valve plasty: an early experience.Ann Thorac Surg. 2010; 89: 1620-1624Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar] reported the motion angle of the patch decreased from 41 degrees to 35 degrees in 2 years, meticulous follow-up of the PTFE with echocardiography should be mandatory. In addition, there must be a limitation of this procedure for functional MR. The indication of this procedure with regard to the tethering height or other index should be delineated in the future. Use of an Expanded Polytetrafluoroethylene Patch as an Artificial Leaflet in Mitral Valve Plasty: An Early ExperienceThe Annals of Thoracic SurgeryVol. 89Issue 5PreviewThe purpose of this study was to examine the usefulness of polytetrafluoroethylene (PTFE) patches as artificial mitral leaflets in complex mitral valve plasty. Full-Text PDF