Mitral annuloplasty ring design and selection: Complete semi-rigid is best

Chotivatanapong, Taweesak

doi:10.1016/j.xjtc.2021.10.036

Cited by 4 publications

(6 citation statements)

References 17 publications

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“…Stiff or moderately flexible rings appeared to stabilize the annulus significantly better than highly flexible ones [10,11] so that the use of the latter did not play a role in this study. Procedural characteristics for the valvular apparatus changed markedly from mainly classical…”

Section: Plos Onementioning

confidence: 74%

“…These particular changes comprised wider rings with multi-layer fabric to allow for better stitching and more secure anchoring. Stiff or moderately flexible rings appeared to stabilize the annulus significantly better than highly flexible ones [ 10 , 11 ] so that the use of the latter did not play a role in this study. Procedural characteristics for the valvular apparatus changed markedly from mainly classical resection maneuvers to predominant use of artificial chordae [ 12 – 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Every day mitral valve reconstruction: What has changed over the last 15 years?

et al. 2022

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Objective Mitral valve reconstruction (MVR) is one of the cardiosurgical procedures which cannot be substituted by any intervention owing to the quality of the quasi-anatomical, physiological repair. However, technique and strategies have changed over the years. We looked at procedural characteristics and outcome in an all-comer, non-selected cohort of patients. Methods 738 out of 1.977 patients were retrospectively analyzed receiving MVR with and without concomitant procedures. The cohort was divided into three periods. P1: 2004–2009 (134 pts.); P2: 2010–2014 (294 pts.), and P3: 2015–2019 (310 pts.). Results Early mortality increased from P1 to P2 and decreased from P2 to P3 (9% P1, 13% P2, 10% P3). All patients received an annuloplasty-ring. In P1 resection measures dominated. In P3 artificial chordae were dominant. Age, BMI, and risk scores correlated with early mortality. Survival rates were 66% (5-years), 55% (10-years), 44% (15-years) in P1, 63% (5-years), 50% (10-years) in P2, and 80% (5-years) in P3. Odds ratio for reduced long-term survival were concomitant venous only bypass surgery (10-years 2,701, p = 0.026). 10-year survival was positively influenced by isolated MVR (0.246, p = 0.001), concomitant isolated arterial bypass (IMA) (0.153, p = 0.051), posterior leaflet measure (0.178, p<0.001), and use of artificial chordae (5-years 0.235, p<0.001). Conclusion Indication for ring implantation remained mandatory while preference changed alongside improved designs. Procedural characteristics changed from mainly resection maneuvers to predominant use of artificial chordae. Long-term results were negatively influenced by co-morbidities and positively influenced by posterior leaflet repair and artificial chordae. MVR underwent a qualitative evolution and remains a valuable cardiosurgical procedure.

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Section: Plos Onementioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Every day mitral valve reconstruction: What has changed over the last 15 years?

et al. 2022

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“…There is increasing evidence of the benefits of the ring. Rigid or semi-rigid rings seem to stabilize the annulus considerably more effectively than highly flexible ones [ 11 , 12 ]; thus, the patients with flexible rings were not included in our study. In contrast, many different techniques are used to repair the leaflet and leaflet-retaining apparatus.…”

Section: Discussionmentioning

confidence: 99%

“…The Alfieri stitch, the surgical predecessor of the MitraClip, was one such technique. Nowadays, however, it is seldom performed surgically although being very fast [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. During our 20 years of experience, we came across a simplification of the classic quadrangular resection maneuver by performing a reverse plication instead of resection or a neo-chordae implantation.…”

Section: Discussionmentioning

confidence: 99%

Simple and Safe: Inverse Plication of the Posterior Mitral Leaflet in Everyday Mitral Valve Reconstruction with and without Concomitant Procedures

et al. 2023

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Objective: Cardiosurgical mitral valve repair (MVR) cannot be easily replaced by other interventional procedures due to the complexity of mitral valve regurgitation as well as physiologic and anatomic repair techniques. A wide variety of techniques have been adopted for proper reconstruction of posterior leaflet prolapse. We investigated the long-term results of quadrangular resections and compared them with a simplified reconstruction maneuver, the inverse plication. Methods: We retrospectively collected data from 1977 patients after mitral valve repair between 2004 and 2022. After considering inclusion and exclusion criteria, we analyzed data from 180 patients after MVR with and without concomitant procedures such as CABG and/or aortic valve replacement (AVR). All MVRs were performed with a semi-rigid annuloplasty ring. A total of 180 patients received quadrangular resection (QuadRes, N = 120)) or inverse plication (InvPlic, N = 60) of the posterior leaflet, among other measures. Demographic data, risk factors, procedure times, hospitalization time, early and long-term mortality as well as Kaplan–Meier survival were analyzed. Results: Age (65.3 vs. 63.1 years) and sex (28.8% female vs. 337.5% female) did not differ significantly, and the EuroSCORE was significantly higher in the InvPlic group (6.46 ± 2.75) than in the QuadRes group (5.68 ± 3.1). Procedural times did not differ for cardiopulmonary bypass, and were as follows: InvPlic 136 ± 44 min; QuadRes 140 ± 48 min; X-Clamp: InvPlic 91 ± 31 min; QuadRes 90 ± 32 min. Hospitalization time was slightly but insignificantly lower in the InvPlic group (15.5 days) than in the QuadRes group (16.1 days). Early mortality (5.08% vs. 8.33%) and re-do procedures (1.69% InvPlic; 6.67% QuadRes) did not differ significantly. However, long-term mortality was significantly lower in the InvPlic group (15.25% vs. 32.32%, p = 0.029). Conclusions: Among the surgical measures for the posterior leaflet, inverse plication appears to be non-inferior to quadrangular resection in unselected all-comer patients. Long-term results and absence of re-do procedures indicate very good stability. Thus, inverse plication not only allows correction of PML, but is also completely safe in the long term and can replace quadrangular resection, especially in patients where a reduction in technical challenges and procedure duration is desired.

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“…The surgeon's experience and preference are important in choosing the type of valve ring to ensure good long-term results. 16 , 17 , 18 Transesophageal echocardiography is used for assessment of mitral valve and repair results the same way as in other types of mitral valve. Both diastolic and systolic parameters as well as coaptation depth are measured for acceptability, prediction of success, and durability of the repair.…”

Section: Systolic Function Techniquesmentioning

confidence: 99%