Abstract
Objective
Though annuloplasty using a properly sized ring has been advocated in degenerative mitral regurgitation, restrictive annuloplasty using a down-sized ring is widely used in ischemic mitral regurgitation. We investigated the outcome of restrictive annuloplasty using a small (24- or 26-mm) ring in mitral regurgitation irrespective of the etiology.
Methods
Nineteen patients underwent a restrictive annuloplasty using a 24-mm (n = 8) or 26-mm (n = 11) semi-rigid ring. The etiology included degenerative in 13 patients, ischemic in 3, endocarditis in 2, and congenital in 1. Body surface area of the patients implanted with the 24-mm ring was 1.40 ± 0.16 and 1.60 ± 0.18 m2 for the 26-mm ring. Fifteen patients had 3+ or 4+ mitral regurgitation preoperatively.
Results
Two patients were converted to valve replacement for residual mitral regurgitation during the operation. One operative mortality associated with infection was observed. Echocardiogram at 29.4 ± 14.2 months postoperatively demonstrated mitral valve area of 2.0 ± 0.6 cm2 for 24-mm ring and 2.2 ± 0.5 cm2 for 26-mm ring with indexed mitral valve area of 1.4 ± 0.4 cm2/m2 for both groups, and no mitral regurgitation more than 2+. Transmitral mean pressure gradient on rest was 4.7 ± 2.1 mmHg at last follow up. New York Heart Association class improved from 2.2 ± 0.7 to 1.2 ± 0.2 after the operation. No late death or reoperation was observed during the follow-up of 31.0 ± 15.0 months.
Conclusions
Restrictive mitral annuloplasty using a small ring provided acceptable early and midterm results in patients with body surface area around 1.5 cm2 without Barlow pathology. Restrictive annuloplasty may be another technical aspect to avoid valve replacement.
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References
Carpentier A. Cardiac valve surgery-the “French correction”. J Thorac Cardiovasc Surg. 1983;86:323–37.
Carpentier AF, Lessana A, Relland JY, Belli E, Mihaileanu S, Berrebi AJ, et al. The “Physio-ring”: an advanced concept in mitral valve annuloplasty. Ann Thorac Surg. 1995;60(5):1177–85.
Magne J, Senechal M, Mathieu P, Dumesnil JG, Dagenais F, Pibarot P. Restrictive annuloplasty for ischemic mitral regurgitation may induce functional mitral stenosis. J Am Coll Cardiol. 2008;51(17):1692–701.
Jebara VA, Mihaileanu S, Acar C, Brizard C, Grare P, Latremouille C, et al. Left ventricular outflow tract obstruction after mitral valve repair. Results of the sliding leaflet technique. Circulation. 1993;88(Part 2):II30–4.
Braun J, van de Veire NR, Klautz RJM, Versteegh MIM, Holman ER, Westenberg LLM, et al. Restrictive mitral annuloplasty cures ischemic mitral regurgitation and heart failure. Ann Thorac Surg. 2008;85:430–7.
Bolling SF, Pagani FD, Deeb GM, Bach DS. Intermediate-term outcome of mitral reconstruction in cardiomyopathy. J Thorac Cardiovasc Surg. 1998;115:381–8.
Tulner SAF, Steendijk P, Klautz RJM, Bax JJ, Vesteegh MIM, van der Wall EE, et al. Acute hemodynamic effects of restrictive mitral annuloplasty in patients with end-stage heart failure: analysis by pressure-volume relations. J Thorac Cardiovasc Surg. 2005;130:33–40.
Magne J, Mathieu P, Dumesnil JG, Tanne D, Dagenais F, Doyle D, et al. Impact of prosthesis-patient mismatch on survival after mitral valve replacement. Circulation. 2007;115:1417–25.
Umesue M, Baba H, Matsui K. Mitral valve repair by leaflet sliding and annular downsizing in active infective endocarditis. Ann Thorac Surg. 2009;88:269–71.
Brown ML, Schaff HV, Li Z, Suri RM, Daly RC, Orszulak TA. Results of mitral valve annuloplasty with a standard-sized posterior band: is measuring important? J Thorac Cardiovasc Surg. 2009;138:886–91.
Mihaileanu S, Marino JP, Chauvaud S, Perier P, Forman J, Vissoat J, et al. Left ventricular outflow obstruction after mitral valve repair (Carpentier’s technique). Proposed mechanisms of disease. Circulation. 1988;78(suppl I):I78–84.
Carpentier A. The sliding leaflet technique. Le Club Mitrale Newsletter 1988;1:2–3.
Grossi EA, Galloway AC, Kallenbach K, Miller JS, Esposito R, Schwartz DS, et al. Early results of posterior leaflet folding plasty for mitral valve reconstruction. Ann Thorac Surg. 1998;65:1057–9.
Chauvaud S, Jebara V, Chachques JC, Asmar BE, Mihaileanu S, Perier P, et al. Valve extension with glutarardehyde-preserved autologous pericardium. J Thorac Cardiovasc Surg. 1991;102:171–8.
Jassar AS, Minakawa M, Shuto T, Robb D, Koomalsingh KJ, Levack MM, et al. Posterior leaflet augmentation in ischemic mitral regurgitation increases leaflet coaptation and mobility. Ann Thorac Surg. 2012;94:1438–45.
Thomas JD, Wilkins GT, Choong CY, Abascal VM, Palacios IF, Block PC, et al. Inaccuracy of mitral pressure half-time immediately after percutaneous mitral valvotomy. Dependence on transmitral gradient and left atrial and ventricular compliance. Circulation. 1988;78:980–93.
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Umesue, M., Baba, H. & Kimura, S. Immediate and mid-term result of restrictive mitral annuloplasty using a small semi-rigid ring. Gen Thorac Cardiovasc Surg 64, 260–266 (2016). https://doi.org/10.1007/s11748-016-0631-6
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DOI: https://doi.org/10.1007/s11748-016-0631-6