Preliminary experience in mitral valve repair using the Cosgrove-Edwards annuloplasty ring

There is a wide range of annuloplasty systems available now. However, controversy concerning the choice of annuloplasty device persists. We analyzed our preliminary experience in mitral valve repair using the Cosgrove-Edwards annuloplasty ring. To correct their mitral insufficiency (MI), 118 consecutive patients (mean age, 60.4+/-15.1 years) underwent mitral repair using this annuloplasty device. NYHA functional class 3 or 4 were present in 86.4%. Degenerative heart disease was the cause of MI in 36.6% of the patients, ischemic heart disease in 25.4%, Barlow's disease in 17.8%, and idiopathic dilated cardiomyopathy in 7.6%. Mitral surgical procedures included quadrangular resection and sliding of the posterior leaflet, posterior leaflet decalcification, anterior leaflet repair, the edge-to-edge technique, and chordal repair. Mean follow-up was 25.1+/-14.0 months. There were four in-hospital non-valve-related cardiac deaths, and one in-hospital non-cardiac death. No cases of systolic anterior motion were observed. NYHA functional class improved from 3.3+/-0.7, before repair, to 1.3+/-0.6, at follow-up (P=0.00012), MI from 3.6+/-0.5 to 0.5+/-0.6 (P=0.0096), and left ventricular ejection fraction from 52.0+/-12.2% to 55.4+/-12.0% (P=0.044). Three-year actuarial rates of survival, freedom from thromboembolism, and freedom from mitral reoperation were 96.9, 97.9, and 96.4%, respectively. The Cosgrove-Edwards annuloplasty ring does not combine with systolic anterior motion. It minimizes MI secondary to all causes, and preserves left ventricular function.     

Five-year experience with a suture annuloplasty for mitral valve repair

We present five years' experience with mitral plication annuloplasty, performed with a semicircular buttressed suture around the posterior leaflet in 130 patients (mean age 58 +/- 11 years) with primary mitral valve disease (n = 71) or functional mitral regurgitation (n = 59). In 65 cases the mitral valve itself was also repaired. Concomitant myocardial revascularization was performed in 40 cases and aortic valve replacement in 43. All but three patients were followed up (97.6%). Postoperative echocardiography showed acceptable mitral area (2.28 +/- 0.39 cm2) and good valve competence in all cases. Inhospital mortality was 3% and late mortality 4.8%. During the follow-up period (22.8 +/- 10.9 months) 8 patients (6.6%) required mitral valve replacement because of progression of native valve disease (n = 4), technical failure (2) or expansion of the annuloplasty suture (2). Mitral annuloplasty thus can be performed simply and with good results, using a strong, non-stretchable buttressed suture. This procedure can be an inexpensive alternative to ring implantation.     

The role of annuloplasty in mitral valve repair

Mitral valve repair surgery has progressed dramatically since its inception over 40 years ago. As techniques have evolved, complicated mitral valve reconstruction has become commonplace, with durable late results. Likewise, the value of concomitant annuloplasty during valve repair has been firmly established as contributing to late valve repair durability. This review discusses the evolution of annuloplasty techniques and the physiologic reasoning behind various approaches.     

Modified technique for mitral repair without ring annuloplasty

Mitral valve repair is the procedure of choice to correct mitral regurgitation. Most operative techniques use an annuloplasty ring to provide stability and durability to the correction. We present a modification of existing repair techniques, without the use of an annuloplasty ring, in which plication sutures allow both annular remodeling and stability. Clinical and echocardiographic follow-up in our series of 60 patients with a mean follow-up of 29 months is presented.     

Mitral valve repair by Carpentier-Edwards Physio annuloplasty ring

A semi-flexible annuloplasty ring (Physio-ring) was clinically used in 30 cases of mitral valve insufficiency. The Physio-ring has the characteristics in which the anterior section is rigid and has a saddle-shaped curve, while the posterior section is flexible to allow for changes in size and shape of the anulus during ventricular contraction. The patients were aged from 23 to 73 years (mean 53.8 ± 12.5). The cause of mitral valve insufficiency was degenerative (in 24 patients), rheumatic (2), ischemic (1), endocarditis (1), congenital + degenerative (1), and traumatic (1). On the 6-month post-implant echocardiogram, 96.6% had grade 0 or +1 regurgitation. The effective valve orifice area was 2.61 ± 0.82 cm² (n = 19). There was no late death. However, there was 1 (3.3%) hospital death after the patient had received a simultaneous coronary artery bypass grafting, and then developed low output syndrome after surgery. Although there was no device-related complication, hemolysis of undetermined cause was observed in 1 (3.3%) patient The findings from this study indicated a low incidence of device-related complication, while excellent valvular function was maintained.     

改良二尖瓣成形术治疗小儿二尖瓣反流

目的 总结改良二尖瓣成形术在小儿二尖瓣反流中的治疗经验。方法 1999年3月至2009年12月共收治小二尖瓣中、重度反流行改良二尖瓣成形术患儿106例。全组男69例,女37例;年龄0.4～8.5岁,平均(3.7±1.8)岁;体重6.6 ～52.0 kg,平均(10.0±3.5)kg。术前超声评估左心室功能。按年龄分为3组：＜6个月16例;6个月到2岁51例;2岁到8.5岁39例。另有7例合并二尖瓣狭窄,根据术前血流动力学、功能状况和解剖结构分别采用取不同的手术方法。结果 死亡3例(2.8％),其中2例为术后二尖瓣反流加重严重影响心功能,1例为合并难以纠治的肺高压。其他患儿恢复良好。结论 对于小儿二尖瓣反流行成形术可行,术后早期效果良好,瓣膜发育尚可,再手术率相对较低。对小儿二尖瓣反流早期干预可以减少瓣膜损害。     

Midterm results of edge-to-edge mitral valve repair without annuloplasty

OBJECTIVE: Edge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches. METHODS: From November 1993 to December 2001, 81 patients underwent edge-to-edge mitral repair without associated annuloplasty. The cause was degenerative in most patients. In 32 patients the annulus was severely calcified. Type I lesions were present in 6 patients, type II lesions in 60 patients, and type III lesions in 15 patients. A double-orifice repair was done in 69 patients, and paracommissural repair was done in 12 patients. In 5 patients edge-to-edge repair was used as a rescue procedure. RESULTS: There were 3 hospital and 4 late deaths, for a 4-year survival of 85% +/- 6.7%. At latest follow-up, 63 patients were in New York Heart Association classes I or II, and 9 patients were in classes III or IV. Nine patients required reoperation (89% +/- 3.9% overall freedom from reoperation at 4 years). Annular calcification was associated with a greater reoperation rate (77% +/- 22% vs 95% +/- 4.6% freedom from reoperation, P =.03). Intraoperative water testing and postrepair transesophageal echocardiography predicted late failure. Only 1 of 42 patients required reoperation in the follow-up period when annular calcification, rheumatic disease, or rescue procedure were not present as risk factors. CONCLUSIONS: Our data confirm overall suboptimal results of the edge-to-edge technique when annuloplasty is not added to the repair. Annular calcification, rheumatic cause, and edge-to-edge repair done as a rescue procedure were associated with the worst outcome. Midterm results in selected patients encourage future developments in catheter-based edge-to-edge procedures.     

Mitral valve repair by Carpentier-Edwards physio annuloplasty ring.

A semi-flexible annuloplasty ring (Physio-ring) was clinically used in 30 cases of mitral valve insufficiency. The Physio-ring has the characteristics in which the anterior section is rigid and has a saddle-shaped curve, while the posterior section is flexible to allow for changes in size and shape of the anulus during ventricular contraction. The patients were aged from 23 to 73 years (mean 53.8 +/- 12.5). The cause of mitral valve insufficiency was degenerative (in 24 patients), rheumatic (2), ischemic (1), endocarditis (1), congenital + degenerative (1), and traumatic (1). On the 6-month post-implant echocardiogram, 96.6% had grade 0 or +1 regurgitation. The effective valve orifice area was 2.61 +/- 0.82 cm2 (n = 19). There was no late death. However, there was 1 (3.3%) hospital death after the patient had received a simultaneous coronary artery bypass grafting, and then developed low output syndrome after surgery. Although there was no device-related complication, hemolysis of undetermined cause was observed in 1 (3.3%) patient. The findings from this study indicated a low incidence of device-related complication, while excellent valvular function was maintained.