Mid-term results of mitral valve repair using flexible bands versus complete rings in patients with degenerative mitral valve disease: a prospective, randomized study

Bogachev-Prokophiev, Alexander; Afanasyev, Alexander; Железнев, С. И.; Назаров, В. М.; Sharifulin, Ravil; Karaskov, Alexander

doi:10.1186/s13019-017-0679-0

Cited by 12 publications

(10 citation statements)

References 32 publications

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“…In the current study an average of 3.6 chordae per patient have been implanted, within a mean cross clamp time of 53 minutes in isolated MV-repair and 69 minutes in commitment procedures. These findings are comparable to reports from other investigators, where a mean of 4 to 8 PTFE-chordae per patient were required for a repair within a mean cross clamp time of ∼84-101 minutes based on the type of procedure (15,16).…”

Section: Discussionsupporting

confidence: 88%

A new simplified technique for artificial chordae implantation in mitral valve repair with its early results

Gabry¹,

Mourad²,

Loosen³

et al. 2020

J Thorac Dis

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Background: Many techniques in mitral valve repair (MVR) have been reported with successful longterm results. The aim of this study is to present our simplified technique in artificial chordae replacement for MVR, and reporting its short-term outcomes. Methods: We present a prospective single-surgeon experience. A new simplified artificial chordae implantation technique has been used to repair mitral valves. Postoperative echocardiography at 0, 6, then every 12 months is used to control the results. Endpoints involved freedom from mitral regurgitation (MR), reoperation and major adverse cardiac and cerebrovascular events (MACCE).Results: Between 01/2016 and 01/2018, 57 consecutive patients undergo MVR using this technique are evaluated. Mean age was 63.6±10.1 years and 68.4% were male. Mitral valve pathology was mainly degenerative (52, 91.2%) or healed endocarditis (5, 8.8%). Besides chordae replacement (3.6±1.1 per patient), annuloplasty was used in all patients to correct annulus dilation and stabilize the repair. Mean cross-clamping time was 53±13.4 minutes in isolated MVR and 69.4±31.1 minutes in concomitant procedures. Postoperative outcomes reported two mortalities. Discharge echocardiography reported mild MR in 4 patients and the rest of patients had non-to trace regurgitation. Follow-up results within a mean of 19.3±8.5 months reported no significant MR or need for reoperation and three more (non-valve related) mortalities.Conclusions: Our simplified technique allows to reduce the number of used chordae and re-correction if needed, which consequently reduces cross-clamping and bypass time especially in endoscopic MVR. Good intraoperative and short-term results are reported. These results are still under investigation to prove longterm stability of the repair.

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Section: Discussionsupporting

confidence: 88%

A new simplified technique for artificial chordae implantation in mitral valve repair with its early results

Gabry¹,

Mourad²,

Loosen³

et al. 2020

J Thorac Dis

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“…On the contrary, Spiegelstein et al in a retrospective study showed that in degenerative MR, PR was associated with lower rates of recurrent MR than fl exible rings. 28 A comparison of pericardial and CR annuloplasty also reported similar clinical and echocardiographic outcomes. 5 David et al as well as Okada et al showed signifi cantly better LV function with fl exible rings than with rigid rings 9,15 whilst Bogachev et al reported that LV changes were more signifi cant in the fl exible bands than in rigid rings.…”

Section: Discussionmentioning

confidence: 72%

Long-term outcomes of mitral valve repair with the Classic and Physio rings

Sidiki¹,

Faybushevich²,

Лищук³

et al. 2020

Cor Vasa

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Při plastice mitrální chlopně se dnes ve velké míře používá anuloplastický kroužek (prstenec) Carpentier-Edwards Physio ring, který je zdokonalením klasického tuhého kroužku. Pokusili jsme se srovnat dlouhodobé výsledky anuloplastiky za použití klasického tuhého kroužku (Classic ring, CR) a polotuhého Physio kroužku (PR) při degenerativních změnách na mitrální chlopni. Metody: V počítačové databázi naší instituce bylo vyhledáno 306 pacientů, u nichž byla v období 2005 až 2015 provedena mitrální anuloplastika s použitím klasického kroužku (CR -139 pacientů) nebo kroužku Physio (PR -167 pacientů). Patnáct z nich současně podstoupilo i plastiku trikuspidální chlopně. Z výše uvedeného počtu byla u 92 pacientů (30,1 %) stanovena diagnóza Barlowovy choroby a u 214 pacientů (69,9 %) fi broelastická defi cience. Pacienti měli podobné demografi cké a echokardiografi cké charakteristiky. Výsledky: V perioperačním období došlo k úmrtí 4 (1,3 %) pacientů. Průměrná délka sledování byla 107,4 ± 13,2 měsíců. V obou skupinách -ne však mezi nimi -došlo ke statisticky významnému zvětšení průměru levé komory na konci diastoly i systoly. Desetileté přežití dosáhlo 84,6 % (93,1 % v případě CR a 91,5 % u PR; p = 0,255) a po deseti letech došlo k recidivě mitrální regurgitace (MR) ≥ 2+ u 74,5 % pacientů (88,2 % u CR a 86,3% u PR; p = 0,110). Reoperaci pro neúspěšnost plastiky bylo nutno provést v osmi případech s CR a v šesti případech s PR. Podle Coxovy regresní analýzy byly prediktory neúspěšné plastiky Barlowova choroba, preoperační MR = 4+ a zkrácení šlašinek. Univariační analýza prokázala jako prediktory nepříznivé hodnoty přežití vyšší věk (≥ 70 let), funkční třídu NYHA IV a systolický tlak v plicnici (≥ 40 mm Hg). Závěry: Dlouhodobé výsledky plastiky pro degenerativní MVD s použitím klasického kroužku nebo kroužku Physio jsou srovnatelné. Při degeneraci šlašinek a jejich zkrácení je nutno implantovat umělé šlašinky. Obstrukci výtokového traktu levé komory u Barlowovy choroby lze zcela zabránit použitím velkých kroužků.

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“…Among the mitral studies, 6 used semi-rigid [ 6 , 7 , 9 , 13 , 20 , 27 ], 5 used rigid [ 10 , 13 , 14 , 18 , 24 ], 5 used flexible [ 8 , 11 , 12 , 19 , 27 ] and 2 used biological rings [ 17 , 25 ]. The incidence of dehiscence among ring types was the following: 0.04% flexible; 1.55% semi-rigid; 2.96% rigid and 3.07% in biological (number of patients, respectively: 784; 3750; 608; 163).…”

Section: Resultsmentioning

confidence: 99%

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

Rad

Naruka

Vardanyan

et al. 2021

European Journal of Cardio-Thoracic Surgery

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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.

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Mid-term results of mitral valve repair using flexible bands versus complete rings in patients with degenerative mitral valve disease: a prospective, randomized study

Cited by 12 publications

References 32 publications

A new simplified technique for artificial chordae implantation in mitral valve repair with its early results

A new simplified technique for artificial chordae implantation in mitral valve repair with its early results

Long-term outcomes of mitral valve repair with the Classic and Physio rings

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

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