Preliminary experience in mitral valve repair using theCosgrove?Edwards annuloplasty ring

Abstract

There is a wide range of annuloplasty systems available now. However, controversy concerning the choice of annuloplasty device persists. We analyzed our preliminary experience in mitral valve repair using the Cosgrove-Edwards annuloplasty ring. To correct their mitral insufficiency (MI), 118 consecutive patients (mean age, 60.4+/-15.1 years) underwent mitral repair using this annuloplasty device. NYHA functional class 3 or 4 were present in 86.4%. Degenerative heart disease was the cause of MI in 36.6% of the patients, ischemic heart disease in 25.4%, Barlow's disease in 17.8%, and idiopathic dilated cardiomyopathy in 7.6%. Mitral surgical procedures included quadrangular resection and sliding of the posterior leaflet, posterior leaflet decalcification, anterior leaflet repair, the edge-to-edge technique, and chordal repair. Mean follow-up was 25.1+/-14.0 months. There were four in-hospital non-valve-related cardiac deaths, and one in-hospital non-cardiac death. No cases of systolic anterior motion were observed. NYHA functional class improved from 3.3+/-0.7, before repair, to 1.3+/-0.6, at follow-up (P=0.00012), MI from 3.6+/-0.5 to 0.5+/-0.6 (P=0.0096), and left ventricular ejection fraction from 52.0+/-12.2% to 55.4+/-12.0% (P=0.044). Three-year actuarial rates of survival, freedom from thromboembolism, and freedom from mitral reoperation were 96.9, 97.9, and 96.4%, respectively. The Cosgrove-Edwards annuloplasty ring does not combine with systolic anterior motion. It minimizes MI secondary to all causes, and preserves left ventricular function.

Plastia da valva mitral com a técnica do "Duplo Teflon": resultados de 10 anos

“…The reduction of mitral annular orifice area during systole is mainly due to contraction of posterior annulus [8]. The use of prosthetic mitral rings, especially the rigid rings, makes its normal contraction difficult.…”

Current Discoveries and Interventions for Barlow’s Disease

“…Since large annuloplasty rings are not commonly manufactured, other interventions have been utilized in attempts to reduce SAM. These include reducing the anterior leaflet height [51], performing edge-to-edge repair [52], and using incomplete flexible bands [53,54]. Avoidance of annuloplasty rings altogether has also been advocated [55].…”