Early and Mid-Term Results After Repair of Ischaemic Mitral Regurgitation with Complete Annuloplasty Ring and Incomplete Ring
DOI:
https://doi.org/10.1532/hsf.3893Keywords:
annuloplasty ring, flexible; ischaemic mitral regurgitation, mitral valve, repair, semi-rigidAbstract
Background: The choice of ring type for mitral valve (MV) repair is still debatable and usually is left to the surgeon's discretion.
Aim: The aim of this study was to compare the early and mid-term results after repair of ischaemic mitral regurgitation (MR) with complete and incomplete annuloplasty rings.
Methods: Collected data included preoperative assessment (age, sex, comorbidities, clinical status, NYHA grade, and the EURO score); intraoperative details (echocardiography, degree of MR, and cross-clamp time); and results (the length of ICU and hospital stay, duration and need for inotropes, duration of mechanical ventilation, and postoperative adverse events). Follow up after discharge included assessment of dyspnea status, the degree and progression of MR, and left ventricular function and dimensions.
Results: The present study included 133 patients: 61 with incomplete rings and 72 with complete rings inserted. There was no significant difference in the rate of postoperative complications between the two groups, apart from a significantly higher percentage of patients with incomplete ring who required prolonged ventilation >24 hours (P = 0.002). There were no significant differences between the two groups, regarding the grade of residual MR (P = 0.464), postoperative dyspnea status (P = 0.723), 30-day mortality rate (P = 0.687), and mean duration of survival (P = 0.276).
Conclusion: The choice of incomplete or complete annuloplasty ring was not associated with a marked difference in the early and midterm results of ischaemic MV repair.
References
Alame AJ, Karatasakis A, Karacsonyi J, Danek BA, Sorajja P, Gössl M, et al. 2017. Comparison of the American College of Cardiology/American Heart Association and the European Society of Cardiology Guidelines for the Management of Patients With Valvular Heart Disease. The Journal of Invasive Cardiology. 29(9):320-6.
Bursi F, Enriquez-Sarano M, Nkomo VT, Jacobsen SJ, Weston SA, Meverden RA, et al. 2005. Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation. Circulation. 111(3):295-301.
Carpentier AF, Lessana A, Relland JY, Belli E, Mihaileanu S, Berrebi AJ, et al. 1995. The "physio-ring": an advanced concept in mitral valve annuloplasty. Ann Thorac Surg. 60(5):1177-85; discussion 85-6.
Chee T, Haston R, Togo A, Raja SG. 2008. Is a flexible mitral annuloplasty ring superior to a semi-rigid or rigid ring in terms of improvement in symptoms and survival? Interactive Cardiovascular and Thoracic Surgery. 7(3):477-84.
Cosgrove DM, 3rd, Arcidi JM, Rodriguez L, Stewart WJ, Powell K, Thomas JD. 1995. Initial experience with the Cosgrove-Edwards Annuloplasty System. Ann Thorac Surg. 60(3):499-503; discussion -4.
David TE, Ivanov J, Armstrong S, Christie D, Rakowski H. 2005. A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse. The Journal of Thoracic and Cardiovascular Surgery. 130(5):1242-9.
De Bonis M, Taramasso M, Grimaldi A, Maisano F, Calabrese MC, Verzini A, et al. 2011. The GeoForm annuloplasty ring for the surgical treatment of functional mitral regurgitation in advanced dilated cardiomyopathy. European Journal of Cardiothoracic Surgery: official journal of the European Association for Cardio-thoracic Surgery. 40(2):488-95.
Dion R. 1993. Ischemic mitral regurgitation: when and how should it be corrected? The Journal of Heart Valve Disease. 2(5):536-43.
Dion R, Benetis R, Elias B, Guennaoui T, Raphael D, Van Dyck M, et al. 1995. Mitral valve procedures in ischemic regurgitation. The Journal of Heart Valve Disease. 4 Suppl 2:S124-9; discussion S9-31.
Fedak PW, McCarthy PM, Bonow RO. 2008. Evolving concepts and technologies in mitral valve repair. Circulation. 117(7):963-74.
Goldstein D, Moskowitz AJ, Gelijns AC, Ailawadi G, Parides MK, Perrault LP, et al. 2016. Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation. N Engl J Med. 374(4):344-53.
Gorman JH, 3rd, Gorman RC, Jackson BM, Enomoto Y, St John-Sutton MG, Edmunds LH, Jr. 2003. Annuloplasty ring selection for chronic ischemic mitral regurgitation: lessons from the ovine model. Ann Thorac Surg. 76(5):1556-63.
Hu X, Zhao Q. 2011. Systematic evaluation of the flexible and rigid annuloplasty ring after mitral valve repair for mitral regurgitation. European Journal of Cardiothoracic Surgery: official journal of the European Association for Cardio-Thoracic Surgery. 2011;40(2):480-7.
Khamooshian A, Buijsrogge MP, de Heer F, Gründeman PF. 2014. Mitral valve annuloplasty rings: review of literature and comparison of functional outcome and ventricular dimensions. Innovations (Philadelphia, Pa). 9(6):399-415.
Kron IL, Hung J, Overbey JR, Bouchard D, Gelijns AC, Moskowitz AJ, et al. 2015. Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery. 149(3):752-61.e1.
Kron IL, LaPar DJ, Acker MA, Adams DH, Ailawadi G, Bolling SF, et al. 2017. 2016 update to The American Association for Thoracic Surgery (AATS) consensus guidelines: Ischemic mitral valve regurgitation. The Journal of Thoracic and Cardiovascular Surgery. 153(5):e97-e114.
Michler RE, Smith PK, Parides MK, Ailawadi G, Thourani V, Moskowitz AJ, et al. 2016. Two-Year Outcomes of Surgical Treatment of Moderate Ischemic Mitral Regurgitation. N Engl J Med. 374(20):1932-41.
Onorati F, Rubino AS, Marturano D, Pasceri E, Mascaro G, Zinzi S, et al. 2009. Mid-term echocardiographic results with different rings following restrictive mitral annuloplasty for ischaemic cardiomiopathy. European Journal of Cardio-Thoracic Surgery: official journal of the European Association for Cardio-Thoracic Surgery. 36(2):250-60; discussion 60.
Otsuji Y, Levine RA, Takeuchi M, Sakata R, Tei C. 2008. Mechanism of ischemic mitral regurgitation. Journal of Cardiology. 51(3):145-56.
Pang PYK, Huang MJ, Tan TE, Lim SL, Naik MJ, Chao VTT, et al. 2019. Restrictive mitral valve annuloplasty for chronic ischaemic mitral regurgitation: outcomes of flexible versus semi-rigid rings. Journal of Thoracic Disease. 11(12):5096-106.
Pérez de Isla L, Zamorano J, Quezada M, Almería C, Rodrigo JL, Serra V, et al. 2007. Functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome: contribution to congestive heart failure. Eur Heart J. 28(23):2866-72.
Saitto G, Lio A, Russo M, Nicolò F, Bassano C, Scafuri A, et al. 2018. Mitral Valve Repair with a Semi-Rigid C-Band Annuloplasty Ring in Ischemic Mitral Regurgitation: Still a Viable Surgical Option? The Journal of Heart Valve Disease. 27(1):47-54.
Silberman S, Klutstein MW, Sabag T, Oren A, Fink D, Merin O, et al. 2009. Repair of Ischemic Mitral Regurgitation: Comparison Between Flexible and Rigid Annuloplasty Rings. The Annals of Thoracic Surgery. 87(6):1721-7.
Suri RM, Schaff HV, Dearani JA, Sundt TM, 3rd, Daly RC, Mullany CJ, et al. 2006. Recurrent mitral regurgitation after repair: should the mitral valve be re-repaired? The Journal of Thoracic and Cardiovascular Surgery. 132(6):1390-7.
Rausch MK, Bothe W, Kvitting JP, Swanson JC, Miller DC, Kuhl E. 2012. Mitral valve annuloplasty: a quantitative clinical and mechanical comparison of different annuloplasty devices. Annals of Biomedical Engineering. 40(3):750-61.
Rossi A, Dini FL, Faggiano P, Agricola E, Cicoira M, Frattini S, et al. 2011. Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy. Heart (British Cardiac Society). 97(20):1675-80.
Yokote J, Araki Y, Saito S, Hasegawa H, Usui A. 2019. Effect of an artificial ring on mitral valve function. Nagoya Journal of Medical Science. 81(2):207-15.
