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Chord Implantation In Growing Hearts - Surgical Outcome Of Artificial Chords For Mitral Valve Repair In Children: A Matched Case-control Study
Mimi X. Deng, MD1, Julia Ingarao
2, Shuhua Luo, MD, PhD
3, Marisa Signorile, MMath
4, Kyle Runeckles, MSc
4, Lynne E. Nield, MD
2, Jaymie Varenbut, BScH
2, Chun-Po Fan, PhD
4, Christoph Haller, MD
2, Osami Honjo, MD PhD
2.
1University of Toronto, Toronto, ON, Canada,
2SickKids Hospital, Toronto, ON, Canada,
3West China Hospital of Sichuan University, Chengdu, China,
4Ted Rogers Computational Program, Toronto, ON, Canada.
Objective(s): To evaluate the surgical outcomes of pediatric patients who underwent mitral valve (MV) repair using artificial chords (AC), compared to repair without AC.
Methods: Retrospective single-center study of 44 consecutive (2005-2021) children who underwent MV repair using AC, matched to patients who received repair without AC (control), based on body size and concomitant procedure.
Results: The median operative age of the AC cohort was 41.7mo (IQR 15.0-144.2). Patients in the AC group had more severe MV disease, as reflected in greater prevalence of bileaflet dysplasia (55 vs 25%, p<.001), severe MR (75 vs 52%), and increased left ventricular end-diastolic diameter (p=.063). The AC group had longer cardiopulmonary and cross clamp times (110 vs 66 min, p<.001), suggesting increased complexity repair. At median follow-up of 4.27yr (1.18-7.50), rate of MV reintervention (
Figure 1A) was comparable, with highest rate of reintervention observed in the first year. Five-year survival was 97.1% and 96.6% in the AC and control cohorts, respectively. Significant residual MR at discharge (odds ratio 4.38, p=.006) and operative age less than 5 years (
Figure 1B) were associated with MV reintervention.
Conclusions: AC is reserved for repair of severe MV pathology and provides medium-term durability that is equivalent to more straightforward repairs without AC implantation. Residual ≥moderate MR remains a prominent risk factor for MV reintervention, as well as young operative age.
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