Abstract
BackgroundMitral valve repair with the use of an annuloplasty ring is the procedure of choice in patients with significant mitral regurgitation (MR) due to floppy mitral valve (FMV)/mitral valve prolapse (MVP). The mitral annular size, shape and motion may vary substantially among patients and thus, commercially available rings may not be suitable for each individual patient.MethodsA “personalized ring” (PR) was easily constructed in the operating room using a Dacron sheet and titanium ligating clips to custom fit to each individual mitral annulus shape and size. There were 127 patients with severe MR due to FMV/MVP that underwent mitral valve repair surgery; 58 patients received a PR and 69 patients received a commercial Carpentier-Edwards Physio II ring. The patient records were retrospectively analysed.ResultsThere were no surgical deaths. In-hospital length-of-stay and blood transfusions were not statistically different between the two groups. Mitral valve area was greater (p < 0.05) in the PR group (3.78 ± 0.22) compared to the Physio II ring group (3.13 ± 0.21). Mitral annular area changed from systole to diastole by 14.35% ± 3.28% in the PR group and did not change in the Physio II ring group (p < 0.05). Systolic anterior motion (SAM) of the mitral valve occurred in 2 patients with the Physio II ring and no patients with the PR. Up to 8 years follow-up, all patients in both groups were alive with NYHA functional class I-II symptoms and mild or less MR.ConclusionsThe PR is suitable for all patients with significant MR due to FMV/MVP who require MV repair. The precise fit of the PR to the mitral annulus better preserves valve area and sphincter function of the mitral annulus, prevents SAM and provides excellent short and long-term results.
Highlights
Mitral valve surgery is indicated in almost all symptomatic patients with significant mitral regurgitation (MR) due to floppy mitral valve (FMV)/mitral valve prolapse (MVP)
Key question Whether mitral valve repair with a personalized ring is better in preserving mitral valve function compared to the Physio II ring
Take home message Mitral valve repair with the personalized ring better preserves physiologic function of mitral valve compared to the Physio II ring
Summary
Mitral valve surgery is indicated in almost all symptomatic patients with significant mitral regurgitation (MR) due to floppy mitral valve (FMV)/mitral valve prolapse (MVP). Over the last two decades at St. Luke’s Hospital, Thessaloniki, Greece, more than fifteen hundred surgical mitral valve repairs in patients with MR due to FMV/MVP were performed. Luke’s Hospital, Thessaloniki, Greece, more than fifteen hundred surgical mitral valve repairs in patients with MR due to FMV/MVP were performed Over this long period of time and extensive experience, it became apparent that commercially available full rings did not restore physiological annular function. Mitral valve repair with the use of an annuloplasty ring is the procedure of choice in patients with significant mitral regurgitation (MR) due to floppy mitral valve (FMV)/mitral valve prolapse (MVP). The mitral annular size, shape and motion may vary substantially among patients and commercially available rings may not be suitable for each individual patient
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