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Repair of Ischemic Mitral Regurgitation: Comparison Between Flexible and Rigid Annuloplasty Rings
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| 19.06.2009, 14:46 |
Background. The surgical treatment of ischemic mitral
regurgitation (MR) usually involves implantation of an
annuloplasty ring. We compared results of mitral valve
repair using a flexible or a rigid annuloplasty ring in
patients with ischemic MR undergoing coronary artery
bypass graft surgery.
Methods. There were 169 patients. A flexible ring was
implanted in 117 and a rigid ring in 52. Age and clinical
profile, degree of left ventricular dysfunction, and degree
of MR (mean 3.2) were similar between groups.
Results. Operative mortality was 9% in each group.
Follow-up (58 30 months for flexible group and 14 7
months for rigid group) was available for 91%. For the
flexible and rigid ring groups, respectively, mean New
York Heart Association functional class was 1.9 and 1.6,
with 33% and 14% in classes III to IV (p 0.03); mean
MR grade was 1.25 and 0.7 (p 0.006). There was no
difference in left ventricle function or dimensions. At
follow-up, 29 patients (34%) in the flexible group had
residual MR of moderate degree or greater compared
with 6 (15%) in the rigid group (p 0.03). Mean tricuspid
incompetence gradient was 39 and 34 mm Hg (p
nonsignificant); however, the degree of reduction was
greater in the rigid group (p 0.001). Late mortality was
observed in 32 patients, all in the flexible group.
Conclusions. Clinical and hemodynamic results are
better with rigid mitral annuloplasty rings compared
with flexible rings. That result may be due to ring design,
which dictates not only the annular diameter but also
annular configuration. Longer follow-up is needed to
determine differences in survival.
(Ann Thorac Surg 2009;87:1721–7)
© 2009 by The Society of Thoracic Surgeons
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