Prosthesis–patient mismatch due to small ring annuloplasty in patients with degenerative mitral insufficiency

Abstract

Mitral valve repair results in excellent clinical outcomes with significant reductions in MI, LAD, and TRPG for all sizes of prosthesis. However, use of a smaller prosthesis may result in a higher mean transmitral pressure gradient, and may inhibit reverse remodeling of the left atrium. Therefore, PPM should be avoided.

Benefit and Risk of Minimally Invasive Mitral Valve Repair for Type II Dysfunction ― Propensity Score-Matched Comparison ―

“…A smaller mitral annuloplasty ring may cause functional mitral stenosis and late-onset AF after MV repair for type II dysfunction. [17][18][19] Therefore, the annuloplasty ring size was significantly larger in the MICS group than in the sternotomy group. Notably, a minimally invasive approach did not significantly increase residual post-repair MR.…”

Late onset of atrial fibrillation in patients undergoing mitral valve repair for type II dysfunction

“…In fact, the size of the prosthetic ring was significantly smaller in patients with late Af than in those without Af in multivariate analysis. We have recently shown that a smallersized prosthesis can cause functional mitral stenosis at the time of mitral valve repair for type II dysfunction [20]. Additionally, functional mitral stenosis after mitral valve repair may occur in patients who receive small annuloplasty rings with subsequent pannus overgrowth, gradually reducing the mitral valve orifice area over time [21][22][23].…”

Should annuloplasty prosthesis be selected dependent on the location of prolapse in mitral valve repair for type II dysfunction?

“…[6][7][8][9] An annuloplasty ring is an essential part of mitral valve repair procedures to remodel the annulus and consequently stabilize the repair for long-term durability. We previously reported 10 that a small-sized prosthesis for mitral valve repair may result in prosthesis-patient mismatch and thus, a largesized prosthesis should be placed. However, the influence of the type of annuloplasty prosthesis on long-term durability has not been fully established.…”