Advance in mitral valve repair using a device flexible in three dimensions. The St Jude Medical-Séguin annuloplasty ring.

Abstract

To allow remodeling of the annulus while respecting natural three dimensional annular movements during mitral valve repair, a new annuloplasty ring (St Jude Medical [SJM]-Séguin annuloplasty ring) was developed. This ring has variable flexibility; that is, it is sufficiently rigid on the anterior portion to maintain intercommissural distance, and sufficiently flexible on the posterior portion to respect left ventricular function and natural three dimensional annular mobility. Fifty patients operated on for pure mitral regurgitation between January, 1994 and June, 1995 were studied. Mean age was 58 years. The cause of mitral insufficiency was degenerative in 80% of the patients, rheumatic in 12%, ischemic in 4%, and infectious in 4%. The operative technique to restore normal valve coaptation was quadrangular resection in 31 cases, commissurotomy and chordal fenestration in 8, use of polytetrafluoroethylene chordae in 6, and chordal shortening or transposition in 5. Annuloplasty with a SJM-Séguin annuloplasty ring was realized in all 50 cases. Transesophageal echocardiographic mitral regurgitation decreased from 3.6 +/- 0.8 to 0.3 +/- 0.2 after repair (p < 0.005). Two post operative deaths due to non valve related complications, were observed. There were no ring related complications, especially no left ventricular outflow tract obstruction due to systolic anterior motion. Patients were all reviewed at a mean follow-up of 12.1 months (range, 9-27 months). All are well, in New York Heart Association functional Class I. Echocardiography showed a mean 0.4 +/- 0.3 mitral regurgitation, absence of any systolic anterior motion, and satisfactory mobility of the annuloplasty ring after the movements of the natural annulus, including non planar deviation. These preliminary results suggest that this annuloplasty ring 1) provides excellent correction of annular dilatation and remodeling of the annulus, 2) avoids systolic anterior motion observed with rigid rings, and 3) preserves physiologic three dimensional annulus motion.