Immediate and mid-term result of restrictive mitral annuloplasty using a small semi-rigid ring

• Published in: General thoracic and cardiovascular surgery 2016-05, Vol.64 (5), p.260-266
• Main Authors: Umesue, Masayoshi, Baba, Hironori, Kimura, Satoshi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Body mass index; Cardiac Surgery; Cardiology; Congenital diseases; Coronary vessels; Echocardiography; Ejection fraction; Endocarditis; Etiology; Female; Heart attacks; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Humans; Ischemia; Male; Medicine; Medicine & Public Health; Mitral Valve Annuloplasty - instrumentation; Mitral Valve Annuloplasty - mortality; Mitral Valve Insufficiency - surgery; Original Article; Patients; Postoperative Complications; Prostheses; Prosthesis Design; Retrospective Studies; Surgical Oncology; Thoracic Surgery; Treatment Outcome
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-016-0631-6

Objective Though annuloplasty using a properly sized ring has been advocated in degenerative mitral regurgitation, restrictive annuloplasty using a down-sized ring is widely used in ischemic mitral regurgitation. We investigated the outcome of restrictive annuloplasty using a small (24- or 26-mm) ring in mitral regurgitation irrespective of the etiology. Methods Nineteen patients underwent a restrictive annuloplasty using a 24-mm ( n  = 8) or 26-mm ( n  = 11) semi-rigid ring. The etiology included degenerative in 13 patients, ischemic in 3, endocarditis in 2, and congenital in 1. Body surface area of the patients implanted with the 24-mm ring was 1.40 ± 0.16 and 1.60 ± 0.18 m 2 for the 26-mm ring. Fifteen patients had 3+ or 4+ mitral regurgitation preoperatively. Results Two patients were converted to valve replacement for residual mitral regurgitation during the operation. One operative mortality associated with infection was observed. Echocardiogram at 29.4 ± 14.2 months postoperatively demonstrated mitral valve area of 2.0 ± 0.6 cm 2 for 24-mm ring and 2.2 ± 0.5 cm 2 for 26-mm ring with indexed mitral valve area of 1.4 ± 0.4 cm 2 /m 2 for both groups, and no mitral regurgitation more than 2+. Transmitral mean pressure gradient on rest was 4.7 ± 2.1 mmHg at last follow up. New York Heart Association class improved from 2.2 ± 0.7 to 1.2 ± 0.2 after the operation. No late death or reoperation was observed during the follow-up of 31.0 ± 15.0 months. Conclusions Restrictive mitral annuloplasty using a small ring provided acceptable early and midterm results in patients with body surface area around 1.5 cm 2 without Barlow pathology. Restrictive annuloplasty may be another technical aspect to avoid valve replacement.