In pediatric mitral valve repair, ePTFE artificial chords demonstrated adaptative elongation alongside ventricular growth, with a 10-year cumulative incidence of ≥moderate MR of 45.5%.
Cohort (n=42)
Does mitral valve repair with ePTFE artificial chords provide durable outcomes and adaptative elongation in pediatric patients?
ePTFE artificial chords in pediatric mitral valve repair demonstrate excellent durability and adaptative elongation alongside left ventricular growth without inducing valve restriction.
OBJECTIVE: To evaluate the long-term remodeling, biological adaptation, and clinical outcomes of expanded polytetrafluoroethylene (ePTFE) artificial chords (AC) used for pediatric mitral valve (MV) repair through comprehensive echocardiographic analysis. METHODS: We retrospectively reviewed all patients < 18 years undergoing MV repair with ePTFE AC between 2005 and 2024. Serial echocardiographic measurements included AC length, MV coaptation geometry, regurgitation severity and stenosis, and left ventricular (LV) volumes. RESULTS: Forty-two patients (median operative age 5 years, interquartile IQR 2-12) underwent MV with AC. Median follow-up was 4.0 years (95% CI: 2.5-7.0). Median AC number was 4 (IQR 2-6). Progressive AC elongation was observed over time, with median diastolic AC length from 1.78 cm (IQR, 1.38-2.07) at discharge to 2.28 cm (IQR, 1.88-2.70) at 10 years, and median systolic length from 1.40 cm (IQR, 1.10-1.58) to 2.10 cm (IQR, 1.60-2.50). AC elongation correlated with LV volumes (end-diastolic and end-systolic, p=0.002 and p=0.018), suggesting coupling with ventricular growth. Transmitral gradients remained stable, no association between AC length and reduced coaptation length or increased tenting height were observed, supporting absence of leaflet restriction. No AC rupture or calcification occurred. At 10 years, cumulative incidence of ≥moderate MR was 45.5% (95%CI: 30.5%, 68.0%), reoperation was 20.1% (95% CI 10.8-37.4), and reprolapse with ≥moderate MR was 12.1% (95%CI: 5.3%, 27.6%). CONCLUSIONS: In pediatric MV repair, ePTFE-AC demonstrated excellent durability and adaptative elongation alongside LV remodeling, without inducing valve restriction. These findings support long-term safety of AC-based repair and highlight ventricular-valvular remodeling in the growing heart.
Fournier et al. (2026) conducted a cohort in Pediatric mitral valve repair (n=42). expanded polytetrafluoroethylene (ePTFE) artificial chords was evaluated on Cumulative incidence of ≥moderate mitral regurgitation at 10 years (95% CI 30.5-68.0). In pediatric mitral valve repair, ePTFE artificial chords demonstrated adaptative elongation alongside ventricular growth, with a 10-year cumulative incidence of ≥moderate MR of 45.5%.