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Repair of ischemic mitral regurgitation: comparison between flexible and rigid annuloplasty rings

Shuli Silberman1, Marc W Klutstein, Tsipora Sabag

  • 1Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel. ssilberman@szmc.org.il

The Annals of Thoracic Surgery
|May 26, 2009
PubMed
Abstract

Insights

Rigid annuloplasty rings for ischemic mitral regurgitation showed better clinical and hemodynamic results than flexible rings. This suggests rigid ring design may improve outcomes in mitral valve repair.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Repair
  • Mitral Valve Disease

Background:

  • Surgical treatment for ischemic mitral regurgitation (MR) typically involves annuloplasty ring implantation.
  • Comparison of flexible versus rigid annuloplasty rings in patients with ischemic MR undergoing coronary artery bypass graft surgery.

Purpose of the Study:

  • To compare the clinical and hemodynamic outcomes of mitral valve repair using flexible versus rigid annuloplasty rings in patients with ischemic MR.

Main Methods:

  • 169 patients with ischemic MR undergoing coronary artery bypass graft surgery were included.
  • 117 patients received a flexible ring, and 52 received a rigid ring.
  • Groups were similar in age, clinical profile, left ventricular dysfunction, and baseline MR severity.

Main Results:

  • Operative mortality was 9% in both groups.
  • At follow-up (mean 58 months flexible, 14 months rigid), the rigid ring group had significantly better New York Heart Association functional class (1.6 vs 1.9) and lower mean MR grade (0.7 vs 1.25).
  • Residual moderate or greater MR occurred in 34% of the flexible group versus 15% of the rigid group (p=0.03). Late mortality was exclusively observed in the flexible ring group.

Conclusions:

  • Rigid mitral annuloplasty rings demonstrate superior clinical and hemodynamic results compared to flexible rings in ischemic MR.
  • Ring design, influencing annular diameter and configuration, may contribute to these improved outcomes.
  • Longer follow-up is necessary to ascertain survival differences between the two ring types.

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