Outcomes of loop technique with ring annuloplasty: a > 10-year experience

Abstract

Objective:We assessed the long-term outcomes of the loop technique with ring annuloplasty for mitral regurgitation from our >10-year experience. Methods:We retrospectively reviewed 362 patients who underwent the loop technique with ring annuloplasty via median sternotomy or right mini-thoracotomy for mitral regurgitation. The median follow-up duration was 4.1 years (interquartile range, 2.3-5.8 years).Results: This study involved 147 women and 215 men (median age, 66.5 years). Mitral regurgitation was caused by Barlow's disease in 27 patients. Seven patients required reoperations (recurrent regurgitation caused by technical issues, n = 3; progression of degenerative disease, n = 4). The 5-and 10-year cumulative incidences of reoperation considering death as the competing event were 1.4% and 5.4%, respectively. The 5-and 10year postoperative cumulative incidences of moderate to severe recurrent mitral regurgitation were 4.7% and 13.0%, respectively. Residual regurgitation ≥ mild (hazard ratio, 6.99; 95% confidence interval, 1.520-32.12; P = .012) was an independent risk factor for reoperation. The independent risk factors for moderate to severe recurrent regurgitation were residual regurgitation ≥ mild (hazard ratio, 9.60; 95% confidence interval, 3.042-30.31; P < .001) and the loop-in-loop technique (hazard ratio, 3.40; 95% confidence interval, 1.058-10.90; P = .040). The median mean pressure gradient was sustained at almost 3.5 mmHg for >7 years. Conclusions:The loop technique with ring annuloplasty provided excellent results with good hemodynamics beyond the mid-term. Residual regurgitation ≥ mild and the loop-in-loop technique may not be preferable for durable outcomes.

Chordal force profile after neochordal repair of anterior mitral valve prolapse: An ex vivo study

“…Some investigations have revealed that even mild residual MR after repair increases the chance of eventual repair failure necessitating reoperation. 3 , 5 , 9 , 15 However, no difference was found in the peak and average forces on the primary and secondary chordae between mild and perfect repair in our study. As described above, if there is some coaptation, secondary chordae are able to share the stress with primary chordae, minimizing the stress on both chords.…”

“… 1 Residual postrepair MR has been a great concern and is known to influence mortality and induce adverse left ventricular (LV) remodeling, recurrence of significant MR, and reoperation. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 Residual MR has been reported to be associated with recurrent severe MR resulting in reoperation, 2 , 4 , 6 , 8 , 10 even in mild cases. 3 , 5 , 9 , 14 In addition, the prevalence of significant MR after MV repair is relatively higher in anterior valve prolapse (AVP) repair compared with posterior valve prolapse repair.…”