Clinical Outcomes after Mitral Valve Repair with the Physio II Annuloplasty Ring

Abstract

Background Mitral valve (MV) repair with annuloplasty is the standard of care in patients with primary degenerative mitral regurgitation (DMR). Newer generations of annuloplasty rings have been developed with the goals of closer reproduction of native annular geometry and easier implantation. This study investigates the short-term and 5-year clinical outcomes of MV repair with the Carpentier-Edwards (CE) Physio II annuloplasty ring. Methods This is an observational study including a total of 486 patients who underwent MV repair for DMR using the CE Physio II annuloplasty ring between 2011 and 2016. Results Mean age was 54.8 ± 12.1 years, 364 patients (74.9%) were males, and 84 patients (17.3%) presented with atrial fibrillation. Mean left ventricular ejection fraction was 62.3 ± 7.3%. Mean logistic EuroSCORE was 2.7 ± 2.4%. New York Heart Association functional class III–IV symptoms were present in 134 (27.6%) patients preoperatively. Isolated MV repair was performed via a right-sided mini-thoracotomy in 479 patients (98.6%). Concomitant procedures included ablation for atrial fibrillation in 83 patients (17.1%) and closure of atrial septum defect in 88 patients (18.1%). Median size of implanted annuloplasty rings was 34 mm (interquartile range: 34–38 mm). Mean cardiopulmonary bypass time was 116 ± 34 minutes and mean cross-clamp time was 74 ± 25 minutes. Thirty-day mortality was 0.4%. The Kaplan–Meier 4-year survival was 98.5%. Freedom from MV reoperation was 96.2 and 94.0% at 1 and 4 years. Conclusion MV repair with the CE Physio II annuloplasty ring is associated with excellent midterm clinical outcome.

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

“…Castillo et al reported no MR in 94.5% and mild MR in 5.5% of 744 patients at predischarge; 98% of patients were using a CE Physio I or II ring ( 3 ). Noack et al have shown that 80% of no MR, 18% of mild MR at discharge, and the rate of not requiring re-MV operation at one and four years were 96.2% and 94.0%, respectively, after MVr with a CE Physio II in 486 patients ( 18 ). David et al found only three patients (0.3%) with moderate MR among 840 patients who underwent MVr using various annuloplasty devices ( 4 ).…”

Repair of Mitral Valves with Severe Annular Dilatation and Abundant Leaflet Tissue Using a Prosthetic Ring with a Large Anterior-Posterior Diameter

“…Ashikhmina observed SAM immediately after cardiopulmonary bypass in 13% of the patients (98 of 761 patients) [ 2 ]. Loulmet and colleagues reported an incidence of SAM of 4% (77 of 1906) [ 4 ] and Noack et al of 2.1% (10/486) [ 6 ]. Some morphologic criteria of valves may be predisposed to develop SAM after repair, such as abundant leaflet tissue, steep aortic-mitral angle, septal hypertrophy, and small c-sept distance.…”

“…They observed a 30-day mortality of 2.1% and reported a survival and freedom from reoperation at 4 years of 93.6 and 93.8%, respectively. Recently, Noack et al reported mid-term results of mitral valve repair using the Physio II ring [ 6 ]. They demonstrated a freedom from MV related reoperations of 96.3 and 94% at 1 and 4 years, respectively.…”

“…This tailored treatment should address, in particular, the potential risk for the development of postoperative systolic anterior motion (SAM). In the limited data available, the incidence of this complication reaches from 2.1% to 13% [ 2 , 3 , 4 , 5 , 6 , 7 ]. This risk is increased significantly by factors such as a small left ventricle, a tall posterior leaflet, a narrow aorto-mitral angle, and an enlarged basal septum [ 7 ].…”