Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

Abstract

OBJECTIVES Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and predisposing risk factors for annuloplasty ring dehiscence include technical and pathological ones. METHODS A systematic database search with pooled analysis was conducted of original articles that only included dehiscence rate of mitral and tricuspid ring in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to November 2020. The outcomes included were dehiscence rate in mitral and tricuspid, type of ring implanted, dehiscence rate by pathology and by ring size and shape. RESULTS Our search yielded 821 relevant studies. Thirty-three studies met the inclusion criteria with a total of 10 340 patients (6543 mitral, 1414 tricuspid) of which 87 (mitral) and 30 (tricuspid) had dehiscence. Overall, dehiscence rate was 1.43%, diagnosed at a median of 4.5 ± 1.0 months postoperatively. A significant difference in mitral dehiscence rate was found by ring type (semi-rigid 1.86%, rigid 2.32%; flexible 0.43%; P < 0.001). There was no significant difference in rate of dehiscence by ring size (P = 0.067) and shape in mitral (P = 0.281) but there was higher dehiscence rate in ischaemic compared to non-ischaemic mitral regurgitation (3.91% vs 1.63%; P = 0.022). Among tricuspid studies, 9 of 10 studies did not report any dehiscence. CONCLUSIONS Although rigid, semi-rigid and flexible annuloplasty rings provide acceptable valve repair outcomes, mitral annuloplasty ring dehiscence is clinically more common among rigid rings. Understanding the multifactorial nature of ring dehiscence will help in identifying the patients at high risk and improve their clinical outcomes.

Five-year follow-up of mitral valve repair versus replacement: a propensity score analysis

“…In this study, we observed two cases of ring dehiscence requiring re-surgery. This complication after atrioventricular valves repair, particularly after mitral valve repair, is not rare and is reported in 13–42% of procedural failures in mitral valve annuloplasty repair [ 25 ]. This complication led us to implement a modified approach by placing four pledgeted sutures on the A1, A3, P1 and P3 segments to reinforce the stability of the ring.…”

The Surgical Treatment of Infective Endocarditis: A Comprehensive Review

“…For instance, annuloplasty, which involves the use of a prosthetic ring to provide leaflet coaptation, limit suture tension, and prevent further annular dilation, is pivotal for achieving stable long-term surgical outcomes. Considerations on the choice of the annuloplasty ring should be made, keeping in mind complications such as ring dehiscence, reported to be higher among rigid rings as opposed to flexible rings [ 19 ]. Additionally, the utilization of the autologous pericardium as an alternative material for annuloplasty in patients with active IE represents an adaptation to the unique challenges posed by the infectious milieu.…”

Prevention of Mitral Ring Dehiscence by a Simple Modification of Suture Placement

“…Studies to date investigated the reasons leading to ring dehiscence after MV annuloplasty, suggesting several factors such as ring or pathology-related characteristics, anatomical-related aspects, or also surgical conditions (i.e., knot-tying technique or suture positions) 1 2 being etiological for this deleterious consequence.…”

“…1 MVR achieves adequate leaflet coaptation and motion, annulus stabilization with ring annuloplasty preventing annular dilatation and restoring its geometry. [2][3][4] Annuloplasty ring dehiscence is a major complication of MVR with devastating consequences, reported in 13 to 42% in the past literature. 2 We chose to address this issue with modification of our suture technique to reduce the tension on the cardinal stress points.…”

“…[2][3][4] Annuloplasty ring dehiscence is a major complication of MVR with devastating consequences, reported in 13 to 42% in the past literature. 2 We chose to address this issue with modification of our suture technique to reduce the tension on the cardinal stress points.…”