The tip of the iceberg: Evaluating the mechanism behind dehiscence of mitral annuloplasty rings

MacArthur, John W.; Boyd, Jack

doi:10.1016/j.jtcvs.2017.08.099

Cited by 4 publications

(2 citation statements)

References 5 publications

(7 reference statements)

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“…Annuloplasty alone only offers a solution for annular tethering while not fully addressing the ventricular aspect, therefore being associated with worsening and recurrent MR [ 50 , 51 ]. The weakened and calcified annular tissue found in ischaemic mitral regurgitation together with more aggressive annular downsizing contributes to creating a clinical picture that exposes the annulus-ring system to greater stresses, thus increasing the risk of dehiscence [ 3 , 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

“…Dehiscence eliminates the annular tension required for adequate leaflet coaptation and results in haemodynamic compromise, usually diagnosed using echocardiography. Whilst the true incidence of ring dehiscence in annuloplasty-based valve repair remains elusive and disputed, evidently, it is a pressing concern that contributes to a significant portion of surgical failures and subsequent reoperation [ 2 , 3 ]. Particularly for annuloplasty-based mitral repair, 13–42% of postoperative procedural failures has been attributed to ring dehiscence, presenting an epidemiological disparity too great to ignore [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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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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