Long-term outcomes after mitral ring annuloplasty for degenerative mitral regurgitation: Duran ring versus...

The preferred choice of annuloplasty ring in mitral surgery has not yet been determined. The study aim was to compare the effects of using two ring types, the Duran and the Carpentier-Edwards, for degenerative mitral valve repair.

The follow up data were reviewed from 294 patients who underwent mitral valvuloplasty for degenerative mitral regurgitation (MR) with either a Carpentier-Edwards ring (n = 153) or a Duran ring (n = 141), between 1994 and 2004. The long-term clinical and echocardiographic outcomes were compared.

There were no inter-group preoperative demographic differences. The preoperative left ventricular (LV) ejection fraction (EF) and MR grade were similar in both groups, but the left atrial (LA) size, LV mass and LV dimension were significantly greater in the CE group. Rates of overall survival, reoperation-free survival and MR (> or = 3)-free survival were similar in the two groups (five-year MR-free survival 75.1 +/- 4.6% for CE and 82.4 +/- 4.5% for Duran; p = 0.83). The CE group showed an overall superior five-year mitral stenosis (MS)-free survival. Significantly more Duran patients had a mean transmitral pressure gradient (MPG) of > or = 10 mmHg (five-year MS (MPG > or = 10 mmHg)-free survival rate: 91.2 +/- 2.8% in for CE and 65.1 +/- 10.7% for Duran group; p = 0.011). The LV EF did not change over time in either group. In contrast, the LV mass and LV dimension decreased significantly after surgery in both groups, but no significant inter-group difference was seen for either index.

Although the Duran and Carpentier-Edwards rings showed comparable long-term outcomes in terms of LV function, MR recurrence, survival and reoperation, a greater tendency towards MS development was observed with the Duran ring, this being most likely due to late pannus formation.