Feasibility and Intermediate Term Outcome of Repair of Prolapsing Anterior Mitral Leaflets With Artificial Chordal Replacement in 152 Patients Gerald.

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Feasibility and Intermediate Term Outcome of Repair of Prolapsing Anterior Mitral Leaflets With Artificial Chordal Replacement in 152 Patients Gerald M. Lawrie, MD, Elizabeth A. Earle, JD, Nan R. Earle, MS The Annals of Thoracic Surgery Volume 81, Issue 3, Pages 849-856 (March 2006) DOI: 10.1016/j.athoracsur.2005.08.077 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Details of the surgical technique employed. (A) Number 5 PTFE suture is passed through the basal portion of the papillary muscle in figure of 8 fashion. (B) Each needle is passed through the edge of the leaflet twice, in a rolling fashion towards the center of each pair. The needle can be seen completing this for the medial pair of chordae. (C) Dots are placed to mark the desired final line of leaflet apposition using a marker pen (top). Note also the four annular 2-0 polypropylene stay stitches. (D) The left ventricle is inflated with saline and the chordal length is adjusted. (E) The annular stay stitches are used to simulate the correct annular size during further insufflation and chordal adjustment. (F) The chordae are tied down and the flexible annuloplasty ring is attached with a continuous 2-0 polypropylene suture. The dots and polytetrafluoroethylene knots are now buried in the line of leaflet position. The Annals of Thoracic Surgery 2006 81, 849-856DOI: (10.1016/j.athoracsur.2005.08.077) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Results of Kaplan-Meier analysis of the influence of the leaflet repaired or nonleaflet repair on the need for reoperation after mitral valve repair. (— = anterior; · = both; – – – = posterior; ····· = neither.) The Annals of Thoracic Surgery 2006 81, 849-856DOI: (10.1016/j.athoracsur.2005.08.077) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig. 3 Results of Kaplan-Meier analysis of the influence of leaflet pathology on need for reoperation after mitral valve repair. The Annals of Thoracic Surgery 2006 81, 849-856DOI: (10.1016/j.athoracsur.2005.08.077) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Results of Kaplan-Meier analysis of the influence of the leaflet repaired or nonleaflet repair on patient survival. (— = anterior; · = both; – – – = posterior; ····· = neither.) The Annals of Thoracic Surgery 2006 81, 849-856DOI: (10.1016/j.athoracsur.2005.08.077) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Results of Kaplan-Meier analysis of the influence on patient survival of coronary artery disease (CAD) and whether or not concomitant coronary bypass (CAB) was performed. (– – – = no CAD; — = CAD plus CAB; · = CAD no CAB.) The Annals of Thoracic Surgery 2006 81, 849-856DOI: (10.1016/j.athoracsur.2005.08.077) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Results of Kaplan Meier analysis of the influence the leaflet repair or no leaflet repair on overall rates of stroke. (— = anterior; – – – = both; -·-·= posterior; ···· = neither.) The Annals of Thoracic Surgery 2006 81, 849-856DOI: (10.1016/j.athoracsur.2005.08.077) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Comparison of the status of the patients at most recent echocardiographic study according to their echocardiographic status at the time of hospital discharge. (Black bar = none/mild, 102; grey bar = moderate, 23; white bar = severe, 10; p = 0.5330.) The Annals of Thoracic Surgery 2006 81, 849-856DOI: (10.1016/j.athoracsur.2005.08.077) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions