Mid-term echocardiographic results with different rings following restrictive mitral annuloplasty for ischaemic cardiomiopathy☆

Abstract

Recurrent CIMR correlates with absent ventricular reverse remodelling. Despite a higher trans-mitral gradient, complete rings achieve better results in the treatment of CIMR.

Impact of increased transmitral gradients after undersized annuloplasty for chronic ischemic mitral regurgitation

“…Complete symmetric rings (Carpentier-Edwards Physio ring) were preferred when CIMR was predominantly due to annular dilation (Carpentier type I), and complete asymmetric rings (Carpentier-McCarthy-Adams ring) when inferior or postero-lateral infarction caused restrictive systolic leaflet motion (Carpentier type IIIb). No patient received incomplete bands during the study period [9]. CPB was standardized: a Dideco (Mirandola, Modena, Italy) tubing set, which included a 40 μm filter, a Stockert roller pump (Stockert Instrumente, Munich, Germany) and a hollow fiber membrane oxygenator (Dideco D903 Avant, Mirandola Modena, Italy).…”

“…Moreover, some authors have argued that in order to avoid recurrent mitral regurgitation, undersized complete rigid or semirigid rings should be utilized, regardless of the risk of an iatrogenic mitral stenosis [7,8]. Accordingly, our group has recently shown the importance of complete semirigid rings -compared to incomplete bands -to improve followup freedom from recurrent CIMR, despite an increase of the transmitral gradients at echocardiographic follow-up with complete rings [9].…”

Combined papillary muscle sling and ring annuloplasty for moderate-to-severe secondary mitral regurgitation

“…It has been hypothesized that semi‐rigid saddle‐shaped rings may support a more physiologic mitral geometry and valvulo‐ventricular stress distribution, and thus result in a more technically sound repair, as opposed to rigid or D‐shaped planar rings . Additionally, annuloplasty bands are generally discouraged for repair of secondary MR, as they have been shown to insufficiently reduce the septal‐lateral annular diameter . The effect that the ring selection had on the rate of recurrent MR and mitral valve geometry in the present study is unknown, as it was underpowered for a proper statistical comparison.…”

The ‘Down-Under Repair’ for Ischaemic Mitral Regurgitation

“…Traditionally ischaemic mitral regurgitation has been addressed by placing an undersized annuloplasty ring to reduce the mitral annulus, increasing the redundancy and hence better coaptation of the mitral valve leaflets [2,3]. Shaped rings such as the saddled, semi-rigid, symmetrical and asymmetrical rings have been designed to reduce papillary muscle restriction with variable effect [5]. However ischaemic mitral regurgitation is not merely the result of annular dilatation but a ventricular disease, which modifies the position of the subvalvular apparatus [1][2][3].…”