Mitral Valve Repair with Isolated Ring Annuloplasty: Mid-term Results of 43 Patients
Isolated Ring Annuloplasty
DOI:
https://doi.org/10.5281/zenodo.8201989Keywords:
Annuloplasty, mitral valve, repair, ringAbstract
Aim: Repair techniques are recommended for mitral regurgitation in appropriate cases. Although there are many different mitral valve repair techniques described, data on the outcomes of patients undergoing isolated ring annuloplasty are limited. In this study, we analyzed the operative and postoperative results of isolated ring annuloplasty.
Material and Method: Forty-three patients who underwent isolated ring annuloplasty for mitral regurgitation were included in the study and the results were analyzed retrospectively. Patients were followed up for 18.4±13.4 months.
Results: The mean age of the patients was 53.9±10.8 years (25 (58.1%) males). According to Carpentier functional classification, 21 (48.8%) patients had type I and 22 (51.2%) patients had type IIIb dysfunction. While 7 (16.3%) patients were planned to undergo intervention for mitral valve only, the majority of patients (36 patients, 83.7%) underwent combined procedures. When the preoperative and postoperative values of our patient group were compared, a statistically significant improvement was observed in functional capacity according to NYHA (p<0.001). In addition, the mitral regurgitation grade of the patients decreased from a mean of 2.37±0.49 to 0.73±0.52 (p<0.001). Improvements in left ventricular end-diastolic diameter, left ventricular end-systolic diameter, pulmonary artery pressure and left atrial size measured at follow-up were statistically significant compared to preoperative data (p<0.001, p=0.001, p=0.001, p=0.007 and p=0.005, respectively).
Conclusions: Isolated ring annuloplasty technique can be safely performed in patients with normal leaflets and subvalvular structures and only annular dilatation. In addition, if the mitral valve anatomy is appropriate, only ring annuloplasty can be performed to correct valve pathology to avoid prolonging cross-clamp and cardiopulmonary bypass time in operations where other long procedures will be performed in addition to mitral valve intervention.
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References
Sand ME, Naftel DC, Blackstone EH, Kirklin JW, Karp RB. A comparison of repair and replacement for mitral valve incompetence. J Thorac Cardiovasc Surg 1987;94:208-19.
Goldsmith IR, Lip GY, Patel RL. A prospective study of changes in the quality of life of patients following mitral valve repair and replacement. Eur J Cardiothorac Surg 2001;20:949-55.
Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143:e72-e227.
Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739-91.
Carpentier AF, Lessana A, Relland JY, et al. The ‘physio-ring’: an advanced concept in mitral valve annuloplasty. Ann Thorac Surg 1995;60:1177–86.
Carpentier A. Cardiac valve surgery--the "French correction". J Thorac Cardiovasc Surg 1983;86:323-37.
Jokinen JJ, Hippeläinen MJ, Pitkänen OA, Hartikainen JE. Mitral valve replacement versus repair: propensity-adjusted survival and quality-of-life analysis. Ann Thorac Surg 2007;84:451-8.
Gamal MA, El-Fiky MM, Gamea MM, Ali I. Mitral valve repair versus replacement in severe ischemic mitral regurgitation systematic review and meta-analysis. J Card Surg 2022;37:1591-8.
Sakamoto Y, Hashimoto K, Okuyama H, et al. Midterm results of mitral valve repair with the Carpentier-Edwards rigid ring. Jpn J Thorac Cardiovasc Surg 2006;54:56-60.
Sideris K, Burri M, Bordne J, et al. Repair of Mitral Valves with Severe Annular Dilatation and Abundant Leaflet Tissue Using a Prosthetic Ring with a Large Anterior-Posterior Diameter. J Clin Med 2022;11:1709.
de Marchena E, Badiye A, Robalino G, et al. Respective prevalence of the different carpentier classes of mitral regurgitation: a stepping stone for future therapeutic research and development. J Card Surg 2011;26:385-92.
Panicker VT, Sreekantan R, Kotera SS. Flexible or rigid ring in mitral annuloplasty-do the results differ? Indian J Thorac Cardiovasc Surg 2020;36:566-71.
Rayhill SC, Castro LJ, Nizyporuk MA, et al. Rigid ring fixation of the mitral annulus does not impair left ventricular systolic function in the normal canine heart. Circulation 1992;86:II26-38.
Castro LJ, Moon MR, Rayhill SC, et al. Annuloplasty with flexible or rigid ring does not alter left ventricular systolic performance, energetics, or ventricular-arterial coupling in conscious, closed-chest dogs. J Thorac Cardiovasc Surg 1993;105:643-58; discussion 658-9.
Geidel S, Lass M, Ostermeyer J. Restrictive mitral valve annuloplasty for chronic ischemic mitral regurgitation: a 5-year clinical experience with the physio ring. Heart Surg Forum 2008;11:E225-30.
Filsoufi F, Salzberg SP, Adams DH. Current management of ischemic mitral regurgitation. Mt Sinai J Med 2005;72:105-15.
McGee EC, Gillinov AM, Blackstone EH, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2004;128:916-24.
Tanemoto K. Surgical treatment of ischemic mitral valve regurgitation. Ann Thorac Cardiovasc Surg 2005;11:228-31.
Otsuji Y, Kumanohoso T, Yoshifuku S, et al. Isolated annular dilation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy. J Am Coll Cardiol 2002;39:1651-6.
Kagiyama N, Mondillo S, Yoshida K, Mandoli GE, Cameli M. Subtypes of Atrial Functional Mitral Regurgitation: Imaging Insights Into Their Mechanisms and Therapeutic Implications. JACC Cardiovasc Imaging 2020;13:820-35.
Glower DD, Bashore TM, Harrison JK, Wang A, Gehrig T, Rankin JS. Pure annular dilation as a cause of mitral regurgitation: a clinically distinct entity of female heart disease. J Heart Valve Dis 2009;18:284-8.
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