A second look at autopericardial mitral annuloplasty

Lishchuk

et al. 2020

Preprint

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.

Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

The Carpentier-Edwards classic and physio annuloplasty rings in repair of degenerative mitral valve disease: A retrospective study

Sidiki¹,

Lishchuk

et al. 2020

Preprint

“…A comparison of pericardial and SR annuloplasty also reported similar clinical and echocardiographic outcomes. [ 1 ]…”

Section: Discussionmentioning

confidence: 99%

“…Mitral valve (MV) repair consists of valvuloplasty and annuloplasty with a rigid, semi-rigid or flexible ring. Annuloplasty rings reduce the mitral annulus (MA) size, prevent its further dilation and restoring proper leaflet coaptation [ 1 ]. The range of available annuloplasty rings is quite extensive and reflects the lack of consensus on the features of a durable and effective device.…”

Section: Introductionmentioning

confidence: 99%

The Carpentier-Edwards Classic And Physio Annuloplasty Rings In Repair Of Degenerative Mitral Valve Disease: A Retrospective Study

Sidiki¹,

Journal of the Saudi Heart Association

Лищук³

et al. 2020

Self Cite

Background Physio 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. Methods In a computerized registry of our institution, 306 patients had 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. Results There 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 and preoperative MR = 4 + 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. Conclusion Long-term outcomes of repair for degenerative MV disease with the Classic and Physio rings are comparable. We also reiterate the importance of large size annuloplasty rings for Barlow's disease to avoid the incidence left ventricular outflow obstruction.

“…Annuloplasty rings reduce the MA size and prevent its further dilation thereby restoring proper leafl et coaptation. 5 The range of available rings is quite extensive and refl ects the lack of consensus on the features of a durable and effective device. Moreover, there exist no clear principles that guide the choice of one type of ring over another in the clinical practice of most surgeons and so, ring selection is usually based on a surgeon's preference rather than evidence.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of mitral valve repair with the Classic and Physio rings

Sidiki¹,

Лищук³

et al. 2020

Cor Vasa

Self Cite

Při plastice mitrální chlopně se dnes ve velké míře používá anuloplastický kroužek (prstenec) Carpentier-Edwards Physio ring, který je zdokonalením klasického tuhého kroužku. Pokusili jsme se srovnat dlouhodobé výsledky anuloplastiky za použití klasického tuhého kroužku (Classic ring, CR) a polotuhého Physio kroužku (PR) při degenerativních změnách na mitrální chlopni. Metody: V počítačové databázi naší instituce bylo vyhledáno 306 pacientů, u nichž byla v období 2005 až 2015 provedena mitrální anuloplastika s použitím klasického kroužku (CR -139 pacientů) nebo kroužku Physio (PR -167 pacientů). Patnáct z nich současně podstoupilo i plastiku trikuspidální chlopně. Z výše uvedeného počtu byla u 92 pacientů (30,1 %) stanovena diagnóza Barlowovy choroby a u 214 pacientů (69,9 %) fi broelastická defi cience. Pacienti měli podobné demografi cké a echokardiografi cké charakteristiky. Výsledky: V perioperačním období došlo k úmrtí 4 (1,3 %) pacientů. Průměrná délka sledování byla 107,4 ± 13,2 měsíců. V obou skupinách -ne však mezi nimi -došlo ke statisticky významnému zvětšení průměru levé komory na konci diastoly i systoly. Desetileté přežití dosáhlo 84,6 % (93,1 % v případě CR a 91,5 % u PR; p = 0,255) a po deseti letech došlo k recidivě mitrální regurgitace (MR) ≥ 2+ u 74,5 % pacientů (88,2 % u CR a 86,3% u PR; p = 0,110). Reoperaci pro neúspěšnost plastiky bylo nutno provést v osmi případech s CR a v šesti případech s PR. Podle Coxovy regresní analýzy byly prediktory neúspěšné plastiky Barlowova choroba, preoperační MR = 4+ a zkrácení šlašinek. Univariační analýza prokázala jako prediktory nepříznivé hodnoty přežití vyšší věk (≥ 70 let), funkční třídu NYHA IV a systolický tlak v plicnici (≥ 40 mm Hg). Závěry: Dlouhodobé výsledky plastiky pro degenerativní MVD s použitím klasického kroužku nebo kroužku Physio jsou srovnatelné. Při degeneraci šlašinek a jejich zkrácení je nutno implantovat umělé šlašinky. Obstrukci výtokového traktu levé komory u Barlowovy choroby lze zcela zabránit použitím velkých kroužků.