Abstract
The purpose of this paper is to present the late clinical results of mitral valve repair with the "Double Teflon" technique. "Double Teflon" technique consists of a quadrangular resection of the posterior leaflet, annulus plication with "pledgetted" stitches over a Teflon patch, and leaflet suture. Between 1994 and 2003, 133 patients with degenerative mitral insufficiency due to ruptured or elongated chordae in the posterior leaflet underwent repair with this technique. The mean patient age was 60.4 years and 60.9% patients were male. According to clinical evaluation, 29.3% of the patients were in New York Heart Association functional class IV, 55.7% in class III and 15.0% in class II. Associated techniques of mitral valve repair were used in 15.2% of the patients; the most common was chordal shortening. Twenty six (19.5%) patients had associated procedures. There was one (0.75%) operative death. In the late postoperative period, 95.5% of the surviving patients were in New York Heart Association functional class I. Linearized rates of thromboembolism, reoperation and death were 0.9%, 0.3% and 0.6% patient/year, respectively. The actuarial survival at 10 years was 94.7% +/- 3.6%. Actuarial freedom from thromboembolism and reoperation were 97.3 +/- 1.5% and 99.2 +/-0.8%, respectively. There were no episodes of hemolysis or endocarditis. Mitral valve repair with "Double Teflon" technique presents low morbimorbidity and good clinical late evolution.
Highlights
Mitral valve prolapse as a result of myxomatous degeneration evolves with a variety of clinical syndromes, which include mitral insufficiency in its most varying degrees
Between April 1994 and December 2003, 133 patients diagnosed with mitral insufficiency with ruptured or elongated tendinous chords of the posterior mitral leaflet as a consequence of myxomatous degeneration underwent mitral valve repair with quadrangular resection by the double-Teflon technique at the Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
One patient (0.7%) required reoperation after 72-month of follow-up due to rupture of another tendinous chord of posterior leaflet and underwent new mitral valve repair
Summary
Mitral valve prolapse as a result of myxomatous degeneration evolves with a variety of clinical syndromes, which include mitral insufficiency in its most varying degrees. The most frequent mechanism of this insufficiency is the tendinous chordae elongation or rupture, especially in the posterior mitral leaflet. There exists a precise indication of mitral valve repair surgery. The aforementioned mechanism is the most frequent cause of mitral insufficiency [1]. In a previous experience published in our service, this etiology corresponded to 25.9% of the patients undergoing mitral valve reconstruction [2]. Lower thromboembolism and endocarditis rates, better rates of survival, preservation of left ventricular function, reduced need of anticoagulation, and lower costs, all were accepted as advantages of mitral valve repair over replacement [3,6]
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