Microsizing using inside suture placement. A simple and versatile technique for precision adjustment of ring...

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Medical Devices

Background:

• Mitral annuloplasty is a surgical procedure to treat mitral regurgitation.
• Residual leaks can occur after mitral annuloplasty, potentially compromising repair success.
• A new technique, microsizing, is introduced to address residual leaks.

Purpose of the Study:

• To describe and evaluate the efficacy of the microsizing technique for eliminating residual leaks during mitral annuloplasty.
• To assess the safety and reproducibility of microsizing in a clinical setting.

Main Methods:

• Microsizing involves repositioning annuloplasty sutures from the outside to the inside of the prosthetic ring.
• This maneuver advances annular segments by approximately 3 mm, allowing for precise adjustment of annular shape and size.
• The technique was applied to 63 patients with moderate to severe mitral regurgitation under intraoperative transesophageal echocardiography guidance over 10 years.

Main Results:

• The overall repair success rate was 100%, with no patient requiring valve replacement.
• Thirteen patients (20.6%) underwent microsizing to eliminate residual leaks, achieving a lower mean post-repair mitral regurgitation grade (0.15) compared to traditional repair (0.30).
• No microsized patient experienced systolic anterior motion, mitral stenosis, or late failure; no reoperations were needed.

Conclusions:

• Microsizing is a safe, simple, and reproducible technique for custom shaping the mitral annulus.
• It effectively eliminates gaps, improves leaflet coaptation, and enhances mitral annuloplasty repair outcomes.
• The technique avoids complications such as stenosis, systolic anterior motion, or late failure.