Implantation of Gore-Tex chordae on aortic valve leaflet to treat prolapse using "the chordae technique": surgical aspects and clinical results.

Background: Repair of prolapsed aortic valve leaflets has been considered a challenging technique for cardiac surgeons. In this paper we describe our surgical approach, "the chordae technique." It consists of the correction of aortic cusp prolapse by shortening the free margin length and of an adjustment of the leaflets coaptation height by anchoring the prolapsing cusp to the aortic wall at the sinotubular junction level.

Methods: Between February 2003 and December 2006, 26 patients with one or more prolapsed aortic leaflets underwent surgical repair using the new approach. The mean age of patients was 55 +/- 10 years. There were 10 (38.5%) patients with grade II aortic valve regurgitation, 4 (15.5%) with grade III, and 12 (46%) with grade IV. Twelve patients had a concomitant aortic root aneurysm requiring surgical treatment. There were 22 patients with tricuspid aortic valve, and 4 were bicuspid.

Results: No in-hospital mortality occurred. The mean in-hospital stay was 8 +/- 2 days. The mean clinical follow-up was 14 +/- 8 months (range, 4 to 36 months). At follow-up, there were 4 (15.5%) patients with trivial aortic valve regurgitation and 22 (84.5%) patients without aortic valve regurgitation. All patients were free from aortic valve reoperation and free from cardiac and thromboembolism events.

Conclusions: In patients with aortic valve regurgitation and cusp prolapse, functional aortic annulus stabilization and the use of the central chordae allows the correction of cusp prolapse and stabilizes the valve repair at follow-up, avoiding a repeat prolapse. We believe that this approach might represent a valuable and safe technique although long-term follow-up is mandatory.