Alternatives in selection of rings for mitral annuloplasty

Mitral valve repair with annuloplasty has become a widely accepted technique for correction of pathologic lesions of the mitral valve. Advantages over mitral valve replacement include improved hemodynamic performance and improved ventricular function. The rate of operative mortality in appropriately selected patients is low. The success of the mitral valve repair has led to increased scrutiny of mitral valve function and a growing realization that rigid rings may be detrimental. Flexible rings are increasingly replacing the rigid ring traditionally used for annuloplasty, with consequent further improvements in ventricular function and cardiac hemodynamics. Other types of rings recently introduced include partially flexible rings and adjustable flexible rings. The advantages of each are discussed. Relatively new procedures involving shortening of the annulus with suture or pericardium show promise.