Comparison of flexible, open with semi-rigid, closed annuloplasty-rings for mitral valve repair

Abstract

Background Mitral regurgitation is a frequent valvular disease, with an increasing prevalence. We analysed the long-term outcomes of mitral valve repair procedures conducted over the last 10 years in our clinic using almost exclusively two different annuloplasty ring types. Methods A single-centre, retrospective analysis of mitral valve surgeries conducted between January 2005 and December 2015 for patients undergoing first-line mitral valve repair with either open (Cosgrove) or closed (CE Physio / Physio II) annuloplasty (OA or CA, respectively) rings. Results In total, 1120 patient documentations were available of which 528 underwent OA and 592 patients CA. The median age of patients was 64.0 years and 41.1% were female. The majority of these patients underwent the procedure because of degenerative valve disease. Rates of successful repair were about 90%, 72 h procedural mortality was 0.6% and the rate of re-intervention was 0.6% within the first 30 days. Functional (mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and systolic diameter and New York Heart Association class) as well as hard outcomes were comparable. 77.7 and 74.4% of patients were alive at the 10-year follow-up in the OA and CA groups, respectively. Upon multivariable adjustment, the hazard ratio was 0.926 (95% CI: 0.642–1.3135; p = 0.681). Conclusions The functional outcome and survival rates up to 10 years after mitral valve repair were comparable using open and closed annuloplasty rings. Whether this means these rings are interchangeable or a carefully selection of the best-for-the-patient devices will be subject of future investigations.

Mitral valve repair using a semi-rigid posterior band: a 10-year Japanese single-center experience of 244 patients

“…These results clarified that the quality and durability of MVr using CGFB were acceptable compared to those of other similar studies. Cetinkaya et al also reported comparable outcomes, such as reMR and LVEF after MVr between a flexible partial band and CE Physio I or II ( 19 ). The type of annuloplasty had no impact on reMR and re-MV surgery over 14 years in 482 patients who underwent MVr using the same procedure with a partial band or complete ring for PML prolapse ( 20 ).…”

Circumflex Coronary Artery Injury during Modern Mitral Valve Surgery—A Review of Current Concepts and Perspectives

“…Various reports describe CX injury during MV repair [ 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 38 , 39 , 41 , 42 , 44 , 46 , 48 , 49 ] and emphasize the importance of accurate and meticulous annuloplasty needle entry angle, direction, depth, instrument manipulation and exteriorization in areas where the CX–CS–MV complex is at risk. Wide posterior leaflet quadrangular resection, extensive posterior sliding plasty and the use of excessively small or large annuloplasty rings should be avoided to minimize the risk of tissue traction, distortion or external compression of the CX in high-risk areas [ 79 , 80 , 81 , 82 , 83 ]. Caruso and colleagues [ 59 ] utilized flexible annuloplasty rings in high-risk CX–CS–MV-complex patients, which accounted for 50% of their series.…”

Looking towards the future: patient-specific computational modeling to optimize outcomes for transcatheter mitral valve repair

“…Annuloplasty ring placement possesses nuance in strategy as well, with closed and open annuloplasty rings both being used for mitral valve repair. There have been equivocal findings on the comparative functional efficacy and survival between the two rings, but recent studies have suggested similar outcomes between the types of annuloplasty rings ( 8 , 9 ). Valve replacement remains the other surgical option by which the entire valve is replaced with a mechanical or tissue-based prosthesis.…”