BackgroundPhysio ring (SR) is considered an improved version of the Classic rigid ring (RR). Today, SR is more widely used in mitral valve (MV) repair. We sought to compare the long-term outcomes of repair with RR and SR in degenerative mitral valve disease.MethodsIn a computerized registry of our institution, 306 patients had isolated MV repair with either RR (139 patients) or SR (167 patients) ring between 2005 and 2015. Fifteen of them had concomitant tricuspid valve repair. Ninety-two (30.1%) had Barlow’s disease and 214 (69.9%) had fibroelastic deficiency. The patients had similar demographic and echocardiographic characteristics.ResultsThere were 4 (1.3%) operative mortalities. Mean follow-up time was 107.4 ± 13.2 months. Left ventricular end diastolic and end systolic diameters significantly improved in both groups but not between groups. Survival at 10 years was 84.6% (93.1% in RR and 91.5% in SR; p = 0.177) and 10-year freedom from recurrent MR ≥ 2 + was 74.5% (88.2% in RR and 86.3% in SR; p = 0.110). Reoperations for repair failure were 8 in RR and 6 in SR. By Cox regression analysis, Barlow’s disease, preoperative MR = 4 + and chordal shortening were predictors of repair failure. Old age (≥ 70 years), NYHA functional class IV and pulmonary artery systolic pressure (≥ 40 mmHg) were predictors of poor survival by univariate analysis.ConclusionLong-term outcomes of repair for degenerative MV disease with the Classic and Physio rings are comparable. Artificial chordal implantation should be used instead of chordal shortening for diseased chordae.