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Physio and Physio II rings: beyond the annular physiology.

Abubakari I Sidiki1, Anastasia A Akulova2, Marina H Hussein2

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The Carpentier-Edwards Physio II ring did not show superior long-term clinical outcomes compared to the Physio I ring in mitral valve repair. Both annuloplasty rings demonstrated similar survival and freedom from recurrent mitral regurgitation at 15 years.

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Area of Science:

  • Cardiovascular Surgery
  • Biomedical Engineering
  • Clinical Outcomes Research

Background:

  • The Carpentier-Edwards Physio I (PR-I) and Physio II (PR-II) annuloplasty rings are designed for mitral valve repair, combining flexibility with remodeling.
  • PR-II features an improved design, including a double saddle and a specialized sewing cuff, intended to reduce suture tension compared to PR-I.
  • While PR-II offers theoretical advantages in annular dynamics, its clinical superiority over PR-I has not been definitively established.

Purpose of the Study:

  • To compare the long-term clinical outcomes of mitral valve (MV) repair using the Physio I (PR-I) and Physio II (PR-II) annuloplasty rings for degenerative disease.
  • To evaluate differences in recurrent mitral regurgitation (MR), long-term survival, cardiac death, and mitral valve-related events (MVREs) between the two ring types.

Main Methods:

  • A retrospective study included 231 patients undergoing MV repair with PR-I and 255 patients with PR-II between 2004 and 2020.
  • Propensity score-matching was employed to create comparable groups of 104 patients each.
  • The primary outcome was recurrent MR ≥3, with secondary outcomes including long-term survival, cardiac death, and MVREs, assessed over a median 15-year follow-up.

Main Results:

  • At 15 years, there were no significant differences in freedom from recurrent MR, overall survival, or cardiac death between the matched PR-I and PR-II groups.
  • Rates of MVREs, encompassing cardiac death, pacemaker implantation, thromboembolism, bleeding, and reoperation, were also similar between the groups.
  • However, a significantly higher rate of recurrent MR was observed at 5 years in the PR-I group compared to the PR-II group (P=0.010).

Conclusions:

  • The type of annuloplasty ring used (PR-I vs. PR-II) did not significantly impact long-term clinical outcomes following mitral valve repair.
  • Despite potential advantages in annular dynamics with the PR-II ring, this did not translate into superior long-term freedom from recurrent mitral regurgitation.
  • Barlow's disease and preoperative MR ≥3 were identified as risk factors for late recurrent MR in multivariate analysis.