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Annuloplasty ring dehiscence after mitral valve repair: incidence, localization and reoperation

Thilo Noack1, Philipp Kiefer1, Nina Vivell1

  • 1University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|August 2, 2019
PubMed
Abstract

Insights

Mitral valve annuloplasty ring dehiscence is uncommon but challenging. Reoperation for this complication, often occurring acutely or early on the posterior annulus, demonstrates favorable short- and long-term survival rates.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Mitral Valve Repair

Background:

  • Mitral valve (MV) annuloplasty ring dehiscence leading to recurrent mitral regurgitation is a rare but significant complication.
  • The incidence, precise localization, and clinical outcomes of this specific complication remain incompletely defined.

Purpose of the Study:

  • To define the incidence, localization, and outcomes of mitral valve annuloplasty ring dehiscence.
  • To analyze short- and long-term survival rates following reoperation for this complication.

Main Methods:

  • Retrospective analysis of 3478 patients undergoing isolated MV repair with ring annuloplasty from 1996 to 2016.
  • Evaluation of 57 patients (1.6%) who required reoperation for annuloplasty ring dehiscence, including echocardiographic data and operative characteristics.

Main Results:

  • Ring dehiscence occurred acutely (<30 days) in 44%, early (≤1 year) in 33%, and late (>1 year) in 23% of cases.
  • Dehiscence was most frequent in the posterior annulus (P3 segment: 68%), followed by P2 (51%) and P1 (47%).
  • 30-day mortality was 2%, with 1-year and 5-year survival rates of 89% and 74%, respectively, after reoperation. MV replacement was performed in 67% and re-repair in 33% of patients.

Conclusions:

  • Annuloplasty ring dehiscence is an infrequent complication of mitral valve repair, typically localized to the posterior annulus.
  • The complication predominantly occurs acutely or early post-repair.
  • Mitral valve reoperation for ring dehiscence is a safe procedure with acceptable survival outcomes.
Keywords:
Mitral regurgitationMitral valveMitral valve repairReoperationRing dehiscence

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