Mitral Valve Repair: Is There Still a Place for Suture Annuloplasty?

Abstract

Prosthetic ring annuloplasty is considered the gold standard technique for mitral valve repair, but it has been associated with some drawbacks. Suture annuloplasty is less expensive and may have some physiopathologic advantages. We reviewed the literature to assess clinical results of mitral suture annuloplasty. Thirteen series, each reporting more than 50 patients and published in the last 10 years, were included in the analysis. They comprised 1,648 patients with cumulative follow-up of 5,607 patient-years. Our review suggests that suture annuloplasty is a safe procedure, but a trend toward recurrence of annular dilatation with time was reported. In selected cases, suture annuloplasty is effective, and its mid-term clinical results are encouraging and compare well with those of prosthetic ring repair series. The quality of the results varies according to the particular annuloplasty technique used and to the mitral valve pathology treated. Recent technical modifications have been found to decrease the incidence of repair failure and promise to improve the reproducibility of the procedure. Further investigations are warranted to better assess the long-term results of suture annuloplasty, and to determine whether its theoretical functional advantages translate into a real clinical benefit.

Long-term survival of two dogs after mitral valve plasty

“…Most of these drawbacks theoretically do not apply to suture AP, although recurrent mitral annular dilatation due to technical failures was initially reported for semicircular suture AP. 10 Semi-circular suture AP 14,15,18 and partial ring AP using ePTFE patch material 13,16 have been used to treat MVP in dogs. However, only one report showed longterm survival after performance of AP.…”

“…2,3 At present, MVP is the preferred treatment because it improves quality of life; however, a repaired valve is less durable than a replaced valve. MVP techniques 4 in humans include chordal reconstruction (CR), 5 annuloplasty (AP), 4,6 and valvuloplasty (VP); 7 for CR and VP, 8,9 but not suture AP, 10 the long-term results and materials used have been essentially established. Although there are some clinical reports of MVP in dogs, [11][12][13][14][15][16][17] only one describes long-term survival after MVP.…”

Plastia valvar mitral pela técnica do Duplo Teflon: análise do remodelamento cardíaco pela ecocardiografia tridimensional

“…The techniques of mitral repair without using prosthetic rings preserve the dynamics of the mitral valve, preserving left ventricular function. Complications related to insertion of a prosthetic material are avoided, and also present a lower cost [17].…”

“…In the technique of quadrangular resection of the posterior cusp, with ring plication and suture edge to edge of the cusps, the use of prosthetic rings is still a subject of discussion [17]. In Brazil, Pomerantzeff et al [18] developed a modified technique using wire with pledgets over Teflon flap for segmental plication of the posterior ring corresponding to the segment removed from the cusp without using prosthetic ring.…”

Análise morfofuncional cardíaca com o uso da ecocardiografia tridimensional em tempo real em indivíduos submetidos à plastia valvar mitral pela técnica de duplo teflon

“…Na técnica de ressecção quadrangular da cúspide posterior, com plicatura do anel correspondente e sutura borda a borda das cúspides, o uso de anéis protéticos ainda é objeto de discussão [45]. No Brasil, POMERANTZEFF et al desenvolveram uma modificação técnica empregando fios com "pledgets" sobre retalho de TEFLON para a plicatura segmentar do anel posterior correspondente ao segmento retirado da cúspide, sem a utilização de anel protético [46].…”