Mitral valve repair using a semirigid ring: patient selection and early outcomes

• Published in: Asian cardiovascular & thoracic annals 2016-09, Vol.24 (7), p.647-652
• Main Authors: Wan, Song, Lee, Alex PW, Attaran, Saina, Yu, Peter SY, Au, Sylvia SW, Kwok, Micky WT, Lau, Rainbow WH, Wong, Randolph HL, Wan, Innes YP, Ng, Siu-Keung, Underwood, Malcolm J
• Format: Article
• Language: English
• Subjects: Aged; Echocardiography, Transesophageal; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Humans; Male; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Annuloplasty - adverse effects; Mitral Valve Annuloplasty - instrumentation; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Patient Selection; Polytetrafluoroethylene; Prosthesis Design; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 0218-4923; 1816-5370
• DOI: 10.1177/0218492316659970

Background Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair. Methods We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative (n = 60) or functional (n = 6) mitral regurgitation had Memo 3D (n = 32) or Memo 3D ReChord (n = 34) rings implanted. Results Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up. Conclusions Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.