Biodegradable Ring Research Articles

Biodegradable annuloplasty rings: evolution, characteristics and surgical technique

Annulus remodeling and stabilization with a ring have been demonstrated to be a mandatory step in mitral and tricuspid valve repair to ensure effective leaflet coaptation and improve long-term results. The need for a degradable ring stems from two areas in which biodegradable ring annuloplasty can theoretically fill a void: 1 – valve repair in infected valve tissue to avoid colonization of permanent implanted ring device and infection recurrence, 2 – valve repair in children, where traditional annuloplasty rings can’t be used due to the risk of acquired stenosis for lack of growth. Prophylactic anticoagulation following biodegradable ring annuloplasty is not necessary, provided that the patient has no other indication for it, as the intraannular position of the ring protects against any «blood-biodegradable ring» interaction.

Mitral Valve Repair with a Biodegradable Annuloplasty Ring for Mitral Regurgitation

Objective: We aimed to evaluate the effectiveness of the mitral valve repair procedure using biodegradable ring implantation to treat severe mitral valve regurgitation. Method: Between May 2007 and 2009, 23 patients without mitral stenosis underwent mitral valve repair using a biodegradable annuloplasty ring. 3 of the 23 patients are excluded from the study due to discontinuation of follow-up. Preoperative, postoperative 7th day, 3rd month, 6th month, and 1st-year echocardiographic data of 20 patients were collected retrospectively and statistically analyzed with Chi-square and Student T-tests. Results: At follow-up, transthoracic echocardiography revealed no or trivial regurgitation. Although there was an increase in the mean gradient during the early postoperative period (7th days and 3rd months), there was no statistically significant difference in the mean gradient between the preoperative and late postoperative period (6th month and 1st year). Mean gradients were 3.48±0.64, 2.72±0.31, 2.62±0.25, and 2.58±0.21 mmHg, respectively at 7th days, 3rd months, 6th months, and 1st year. Increased preload due to mitral regurgitation resulted in larger left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) preoperatively of 194.42±21.39 ml (range, 245.00 to 165.00 ml) and 94.23±36.59 ml (range, 203.35 to 52.80 ml) respectively. The decrease in mean LVEDV and LVESV at 1 year was statistically significant, 130.40±11.04 ml (range, 145.00 to 115.00 ml; p<0.001) and 64.21±13.20 ml (range, 80.08 to 40.25 ml; p<0.001), respectively. Additionally, left ventricular ejection fraction (LVEF) reaches the preoperative value (%51.15±14.04) in the 6th month (%51.58±7.32), although there is a decline in the early postoperative period (%47.11±11.22 on 7th day and 46.35±8.03 in 3rd month). One late death occurred. Mitral valve re-operation was necessary for one rheumatic patient. Conclusion: Annuloplasty using a biodegradable mitral ring has shown desired long-term outcomes with particular advantages compared to traditional annuloplasty rings.

Leakage prevention of entero-colonic anastomoses in emergency surgery

The problem of entero-colonic anastomosis leakage in emergency surgery has always been under close medical community attention. The more proximal intestinal sutures are located, the more severe the consequences are. In case of a left half of the colon the solution of the problem is relatively safe colostomy. Treating a patient with entero-colonic anastomosis leakage, the question arises about the ileostomy, which leads to more serious consequences (water-electrolyte disbalance). Most of these patients get treatment for complicated colon cancer, which worsens the prognosis. In general, the risk of entero-colonic anastomosis leakage in emergency surgery reaches 12.7%. The risks are: inadequate assessment of blood fl ow in the suture line, peritonitis, diabetes, smoking, severe ileus, intraoperative blood transfusion, a small experience of a surgeon in performing these operations. Nowadays there are many ways to prevent anastomosis leakage. They are: application of compression devices of Ni-Ti with simultaneous U-shaped ileostomy, biodegradable rings, consolidation of intestinal sutures with «TachoComb» biopolymer substance application, various adhesive compositions, gland. Oblique intersection of the intestinal wall also uses to increase blood fl ow on the suture line, correction of infusion therapy is discussed with inclusion of hydroxyethyl starch. However, the zero frequency of the leakage in the clinic still cannot be achieved. Accordingly, nowadays, the problem of optimal entero-colonic anastomosis technique remains open. It should meet the following requirements: ideally, a zero frequency of leakage; a technical simplicity of the operation; preferably, without using expensive materials; as far as possible — a valve to prevent refl ux ileitis.

Biodegradable Ring as an Evolving Annuloplasty Technology for Valve Repair

Biodegradable Ring as an Evolving Annuloplasty Technology for Valve Repair

Evaluation of Infection Resistance of Biodegradable versus Conventional Annuloplasty Rings in an in vivo Rat Subcutaneous Model

Background: Biodegradable atrioventricular annuloplasty rings are theoretically more infection resistant due to their intra-annular implantation technique and nonporous structures (monofilament of poly-1,4-dioxanone). The aim of this study was to investigate the infection resistance of a biodegradable annuloplasty ring (Kalangos-Bioring®) in a rat subcutaneous implantation model and to compare it with a commonly used conventional annuloplasty ring (Edwards Physio II®). Methods: This study included 32 Wistar albino rats which were divided into 2 groups according to the implantation of sterile or infected annuloplasty rings as control and study groups. Each animal had 2 implantation pockets (made on the right and left side of the dorsal median line) where 1 cm of the biodegradable annuloplasty ring was implanted into one pocket and 1 cm of the conventional annuloplasty ring was implanted into the other pocket. The infection model was created by topical inoculation of 1 mL Staphylococcus aureus strain (2 × 10⁷ colony-forming units/mL) into the implantation pockets before skin closure. Each group was equally divided into 4 subgroups according to different follow-up schedules. The animals were inspected for local as well as systemic infection signs, and the rings were explanted at weeks 2, 4, 9, and 14 following implantation. Implantation pockets were evaluated macroscopically as well as by histopathological examinations. Microbiological analysis of the explanted implants with surrounding tissue was done by using quantitative sonication method. Results: Conventional ring-implanted pockets showed a more prominent inflammation reaction than the biodegradable ring-implanted pockets, and this characteristic was found to be accentuated with bacterial contamination. The sterile rings did not reveal any positive cultures in either group. The number of positive cultures found in conventional rings contaminated with S. aureus was greater than in the biodegradable ring group (11/16 vs. 2/16 positive cultures, respectively; p = 0.0032). The amounts of growing bacteria in the culture environment were also statistically significantly higher in the conventional ring group (7,175 ± 5,936 vs. 181 ± 130 colony-forming units/mL, respectively; p < 0.0005). Conclusions: This is the first experimental study confirming the theoretical advantage of the infection resistance of the biodegradable annuloplasty ring (Kalangos-Bioring®) when implanted in an active infectious environment. Large animal models mimicking clinical scenarios and clinical comparative studies are needed to verify our results.

Mitral Valve Repair for Congenital Mitral Valve Disease: Impact of the Use of a Biodegradable Annuloplasty Ring

This study compares the midterm results of mitral valve repair using the biodegradable ring versus repair with non-ring annuloplasty techniques for congenital mitral valve disease in young children where it was not possible to use standard commercial rings. Between February 2006 and November 2011, 68 patients underwent mitral valve repair for congenital mitral valve disease. Thirty-nine (57%) patients underwent concomitant annuloplasty using the biodegradable ring (group A) and 29 (43%) patients using non-ring annuloplasty techniques (group B). The median age of repair was 2 years (range 1 month to 14 years). There were no hospital deaths or major postoperative morbidity. At a median follow-up of 3.8 years (range, 2 months to 5.1 years), overall survival at 5 years was 97% ± 3% for group A and 88% ± 8% for group B (p= 0.29). Freedom from valve failure was 90% ± 7% in group A and 74% ± 9% in group B (p= 0.026). The freedom from reoperation was 100% in group A and 84% ± 9% in group B (p= 0.04). The mean transmitral gradients were 4.3 ± 1.8 mm Hg in group A and 4.2 ±1.7 mm Hg in group B (p= 0.77). Mitral valve repair using the biodegradable ring for congenital mitral valve disease was superior compared with non-ring annuloplasty repair. Excellent survival benefit, freedom from reoperation, and valve failure without significant elevation of transmitral gradients, suggests its important role in young children with smaller annular sizes where standard commercial rings are not available or recommended.

Reply to Myers et al.

The authors agree with Myers et al. [1] that biodegradable materials represent a useful alternative in the management of tricuspid valve endocarditis repair. Our statement of dividing tricuspid valve repair choices in prosthetic and non-prosthetic techniques adequately sets the main cornerstones of surgical therapy: first, minimizing, as much as possible, the resulting valve regurgitation following repair and second, equally avoiding the use of any prosthetic material [2]. This is particularly important for injecting drug users who bear a high possibility of re-infection in the future. In this context, biodegradable ring annuloplasty of tricuspid valve could be included in non-prosthetic repair techniques, since after a few months not only would it be degraded, but also the subsequent development of a permanent network of fibrous connective tissue will have restored the normal valve function. Unfortunately, our experience with biodegradable ring annuloplasty or matrix scaffolds such as CorMatrix© is poor. On the contrary, others have noted both preliminary and mid-term successful results using biogradable materials [3] even though, their high cost is not to be dismissed, in the current era of stringent budget. On the other hand, in our and most of the surgeons’ opinion, autologous pericardium represents the primary option in the repair of any endocardial defect (congenital/acquired heart disease). Major advantages include its low cost, easyto-use, perfect incorporation within native structures, uncommon colonization by bacteria, rapid endothelization and high endurance even against high pressures of systemic circulation (left ventricle, aorta, etc.) [4]. Besides, patches of fresh autologous pericardium have been used with excellent shortand long-term results, in repairing mitral regurgitation due to annular dilatation, following posterior mitral annuloplasty [5]. Most importantly, the same material appears to be fundamental in the repair of tricuspid valve disease, particularly among patients with a high risk of long-term prosthetic valve endocarditis [6].

Response to the Letter to the Editor Entitled “Biodegradable Ring Annuloplasty for Valve Repair in Children with Endocarditis”

Dear Editor, We would like to thank the authors for their kindly comments about our experience with valve repair in children with infective endocarditis.1 We have been following up their studies with biodegradable rings, and it was nice to hear that the number of children has clearly increased to whom this biodegradable ring was applied.2 We congratulate the authors for their encouraging results. Although long-term follow-up data are not available, current data revealing no deaths, no reoperations, or valve dysfunction in a follow-up of 56 ± 21 months seems satisfactory for the durability of this biodegradable ring. Previously, our main hesitation was the possible risk of recurrence of infective endocarditis after using such annuloplasty mate-

Application of intracolonic bypass procedure in anus-preserving operation for acute obstructive low and middle rectal cancer

Objective To introduce a novel technique of intracolonic shunt procedure used in the anus - preserving operation for acute intestinal obstruction resulted from cancer at low and middle portions of rectum and assess the clinical significance. Methods In total, 81 patients with acute obstruction of low and middle portion of rectum caused by cancer were randomly ( random number) divided into control group and study group. In control group, 42 patients were operated with preventive transverse colonostomy or terminal ileum stoma after low proximal resection of rectum involved in cancer, while 39 patients were operated with intracolonic shunt procedure by using a biodegradable anastomosis ring and a condom placed 5 cm above anastomosis for protection in study group. Results There were no significant differences in sex, age, tumor site, tumor size and the distance from anstomosis to anal-edge between two groups. In both groups, the bowel movement resumed in 2 ~ 5 days after operation (P > 0.05). In study group, the rate of anastomosis leakage was 7.7% (3/39), and leakages were treated with drainage for 7.1 days in average to be healed, and the biodegradable anastomosis ring detached and were discharged in 14 -23 days (17 days in average), and there were no complications of drainage happened. The anastomotic stenosis occurred in three patients (7. 7% ) within 6 months after operation. In control group, 11.9% patients (5/42) had anastomosis leakage and they treated with drainage for 18.2 days in average to get the leakage healed, and 35. 7% patients (15/42) had stoma complications, and anastomotic stenosis happened in 28.6% patients (12/42) within 6 months after operation, and 7. 1% patients need another operation because of severe anastomosis stenosis. There were no significant differences in rate of anastomosis leakage between tow groups ( P > 0. 05), but there were significant differences in drainage days after anstomosis leakage happened and 6 - months anastomosis stenosis between two groups (P<0.05). Conclusions In the anus -preserving operation for acute intestinal obstruction at low and middle portions of rectum caused by cancer , the intracolonic shunt procedure is convenient and safty, and reduces the hazard incurred by anastomosis leakage and anastomosis stenosis compared with classic stoma operation. Key words: Intracolonic bypass; Rectal neoplasm; Acute intestinal obstrution; Biofragmentable anastomotic ring; Condom; Stoma; Anastomotic leakage; Anastomotic stenosis

Effect of Biodegradable Ring on Dimensions and Dynamics of Mitral Annulus

Effect of Biodegradable Ring on Dimensions and Dynamics of Mitral Annulus

Outcomes of De Vega versus Biodegradable Ring Annuloplasty in the Surgical Treatment of Tricuspid Regurgitation (Mid-term Results)

The aim of this study was to compare De Vega semicircular annuloplasty and a new biodegradable ring annuloplasty technique in patients requiring surgical intervention for tricuspid valve disease with concomitant disease of the mitral valve. Between January 2004 and May 2008, 129 consecutive patients underwent annuloplasty procedures to correct tricuspid valve regurgitation during a concomitant mitral valve operation requiring replacement. Additionally, 24 patients underwent aortic valve replacement (AVR), 11 underwent coronary artery bypass grafting (CABG), 5 underwent AVR plus CABG, 3 underwent mitral valve replacement plus atrial septal defect (ASD) closure, and 2 underwent ASD closure. The patients in this study were assigned to 2 groups: Kalangos ring annuloplasty was performed in 67 patients (group 1), and De Vega semicircular annuloplasty was performed in the remaining 62 patients (group 2). Both tricuspid valve repair techniques produced a low rate of complications; however, the number of patients who developed residual tricuspid regurgitation was significantly lower in group 1. The biodegradable ring annuloplasty technique may be used easily and safely in moderate and severe cases of tricuspid regurgitation; however, larger clinical series are necessary to confirm our promising results.

Midterm Results of Valve Repair With a Biodegradable Annuloplasty Ring for Acute Endocarditis

Conventional annuloplasty rings consist of woven, nondegradable prosthetic material. Their use should theoretically be limited in acute infective endocarditis. Novel biodegradable annuloplasty rings, which are implanted into the annulus, carry theoretical advantages, but have never been evaluated for feasibility and mid-term outcome in such patients. Between 2004 and 2009, 17 consecutive patients with acute infective endocarditis (age, 34.5+/-21.6 years; range, 11-82 years; 8 men) had mitral (n=13), tricuspid (n=3), and mitral and tricuspid (n=1) annuloplasty to conclude valve repair. Repair was performed by complete excision of the infected tissue, valvar reconstruction, and biodegradable ring annuloplasty. Prospectively collected clinical and echocardiographic data were analyzed retrospectively. Indications for surgery were heart failure (n=9; 52.9%), hemodynamic instability (n=8; 47%), and persistent infection or sepsis despite antibiotics (n=6; 35.3%). Staphylococci (n=7) and Streptococci (n=4) were the most common causes. Three patients died on postoperative days 1, 2, and 34 because of massive gastrointestinal bleeding; heart failure and pneumonia; and sepsis and acute renal failure, respectively. During a median follow-up of survivors at 29.6 months (range, 2.0 to 51.0 months), no mortality, recurrence, or reoperation occurred. At follow-up, transthoracic echocardiography revealed no or trivial regurgitation in 11 and mild in 3 patients. Left ventricular dimensions regressed significantly after mitral repair. Valve repair using a biodegradable ring showed good structural and functional properties up to 4 years after repair. Implantation of the biodegradable ring is feasible and effective in patients with acute infective endocarditis. Its intraannular implantation, hindering direct blood contact and associated risk of colonization, represents a theoretical advantage in such patients. Larger comparative studies are needed for further conclusions.

Invited Commentary

In this article, Pektok and colleagues [1Pektok E. Sierra J. Cikirikcioglu M. Müller H. Myers P.O. Kalangos A. Midterm results of valve repair with a biodegradable annuloplasty ring for acute endocarditis.Ann Thorac Surg. 2010; 89: 1180-1186Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar] report their evaluation of the use of a biodegradable annuloplasty ring concomitant with valve repair in patients with infected endocarditis. This article is interesting because it is a new concept with theoretic advantages. I believe that this report is of interest to the readers of the Annals of Thoracic Surgery, and the use of biodegradable ring may alter the current management of infected endocarditis. I agree with their assertion that it is preferable to avoid any foreign material in the contaminated field. The annuloplasty ring is a biodegradable polymer called poly-1,4-dioxanone. The biodegradable polymer apparently degraded completely within 6 months of implantation, leaving a permanent, not so biodegradable monofilament suture material (2-0 polyvinyl). This monofilament suture apparently remains permanently in the annulus of the mitral valve or tricuspid valve where it is used. The greatest question about this annuloplasty ring is the long-term durability of the device. In a study involving mitral valve repair in juvenile pigs published in the Journal of Heart Valve Disease, the authors reported that macroscopic measurements of valve orifice area showed the annulus had grown. They suggested that their annuloplasty ring allows for physiologic growth of the native annulus. However, it is unclear how the annuloplasty ring, which contains a nonabsorbable monofilament, can allow for physiologic growth of the annulus. If dilatation does occurs, this finding raises concern for the long-term support of any valve repair with this annuloplasty device, especially if not used as a complete ring. Long-term follow-up of these patients will be needed to determine if annular enlargement occurs despite the nonbiologic suture and to determine the long-term effects of the partially biodegradable ring compared with pericardium or cloth-covered annuloplasty rings, which have also shown excellent long-term results. Midterm Results of Valve Repair With a Biodegradable Annuloplasty Ring for Acute EndocarditisThe Annals of Thoracic SurgeryVol. 89Issue 4PreviewConventional annuloplasty rings consist of woven, nondegradable prosthetic material. Their use should theoretically be limited in acute infective endocarditis. Novel biodegradable annuloplasty rings, which are implanted into the annulus, carry theoretical advantages, but have never been evaluated for feasibility and mid-term outcome in such patients. Full-Text PDF

Use of a Biodegradable Annuloplasty Ring for Mitral Valve Repair in Children

the ring is completely imbedded inside the native annulus, with the fixation knots at the trigones as the only foreign material exposed, thus no postoperative anticoagulation therapy is required. The biodegradable ring contrasts with the traditional annuloplasty ring where the entire ring is exposed to blood. Prior to obtaining European certification and being commercially available in Europe and Asia, the Kalangos biodegradable annuloplasty ring was tested in an animal model of rapidly growing juvenile pigs. Histological examinations showed that the biodegradable ring was indeed absorbed and gradually replaced by fibrous tissue, with complete degeneration of the ring within 6 months. Macroscopic measurements of the valve orifice also confirmed that the fibrous tissue allowed for physiological growth of the native annulus. 3

Mitral Valve Repair for Rheumatic Valve Disease in Children: Midterm Results and Impact of the Use of a Biodegradable Mitral Ring

Mitral Valve Repair for Rheumatic Valve Disease in Children: Midterm Results and Impact of the Use of a Biodegradable Mitral Ring

Nova tecnologia: valvuloplastias com anéis biodegradáveis

To introduce a new concept in the annuloplasty technology. Although rigid and flexible rings meet the basic needs of adults, they do not preserve the changes in shape and size occurring during the cardiac cycle. If implanted in children, such materials do not allow growth of the native annulus. From March 2003 to March 2007, 207 patients underwent mitral and/or tricuspid valve repair implanting polidioxanone biodegradable rings--Bioring. Patients were divided into two groups: Group 1, Adults: n=121. Mean age: 48 years (+/- 19.2). Oldest 85 years. Group 2, Pediatric: n=86. Mean age: 9.6 years (+/- 4.4). Youngest 0.5 years. Group 1, Hospital mortality: 3.3%. Mean follow-up: 26.4 months +/- 15.4. Four patients underwent mitral valve replacement 1, 2, 2 and 4 months post repair. Group 2, Hospital mortality: 1.2%. Mean follow-up: 26.7 months+/-13.4. Seven mitral reoperations within 1 to 24 months, two for valve re-repair, five for valve replacement. Biodegradable rings remodel the shape, reinforce the repair, restore the function of the atrioventricular valves and maintain the three dimensional dynamic motion and geometry of the mitral and tricuspid valves annulus. Growth potential is preserved in children. Although the biodegradable annuloplasty ring was first designed and developed for a pediatric population, it is currently applied to adult cases. Children with single ventricle and AV valve incompetence are an additional indication. The mid-term results showed that degradation of the device occurred without negative observable consequences. Long-term results should confirm these findings.

Mitral Valve Repair for Rheumatic Valve Disease in Children: Midterm Results and Impact of the Use of a Biodegradable Mitral Ring

Mitral valve repair for rheumatic mitral valve disease in children has become the preferred surgical modality. A mitral valve ring is frequently used in the repair. A recently introduced biodegradable ring has shown promising results and allows for growth of the native annulus. Between January 1994 and March 2006, 220 children underwent mitral valve repair for rheumatic valve disease. Mitral valve insufficiency was predominant in 198 patients (90%). Fifty-seven patients (26%) had associated aortic valve insufficiency and 51 (23%) had tricuspid valve insufficiency addressed during the same surgery. A mitral valve ring was used in 213 patients (173 Carpentier-Edwards and 40 biodegradable rings). Ninety-two percent (202 of 220) were in New York Association class III to IV. Echocardiography was performed at 6 months and thereafter once yearly. There were no hospital deaths or major postoperative morbidity. Follow-up was complete in 96% (212 of 220). One late death occurred. Mean follow-up was 76.4 months (range, 1 to 13 years). One patient (0.5%) had immediate mitral valve repair failure and required mitral valve replacement. Twelve patients (5.5%) required reoperation during follow-up. Recurrent mitral valve insufficiency/stenosis-free survival was 94.5% at 5 years and 92.7% at 10 years. Mean gradient was 5.2 +/- 1.9, 6.2 +/- 2.0, and 7.0 +/- 2.3 mm Hg, respectively, at 7 days, 6 months, and 1 year postoperatively for the Carpentier-Edwards ring and significantly lower (p < 0.001) for the biodegradable ring at 2.8 +/- 0.5, 3.1 +/- 0.7, and 3.3 +/- 0.5 mm Hg, respectively. Unchanged mean gradient during the first year was 65% (26 of 40) for the biodegradable ring and 21% (31 of 147) for the Carpentier-Edwards ring. Mitral valve repair in children with rheumatic valve disease has excellent immediate results with low operative risk and satisfactory midterm results and should therefore be the preferred treatment of choice. The use of biodegradable mitral valve ring results in a significant lower mean gradient during the first year of implantation compared with the Carpentier-Edwards ring and is available in a wide range of sizes.

Initial Clinical Experience with a Novel Biodegradable Ring in Patients with Functional Tricuspid Insufficiency: Kalangos Biodegradable Tricuspid Ring®

Tricuspid annuloplasty procedures have been widely performed in clinics for many years. The Kalangos Biodegradable Tricuspid Ring (Kalangos Biodegradable Tricuspid Ring, Bioring SA, Lonay, Switzerland) is a novel prosthesis for the treatment of tricuspid insufficiency. The aim of this study was to evaluate the clinical and echocardiographic results of this novel prosthesis for functional tricuspid insufficiency. Between October 2005 and May 2006, 15 patients with the diagnosis of moderate or severe functional tricuspid insufficiency were treated by implantation of a Kalangos Biodegradable Tricuspid Ring. All patients were evaluated clinically and by echocardiography preoperatively, and control tests were performed at the end of the 1st and 6th month following surgery. Moderate and severe insufficiency was documented in 11 and 4 patients, respectively, in the preoperative tests. 1 and 6 months after surgery, 4 patients had trace and 1 patient had mild tricuspid insufficiency, while 10 patients had none. At the 1st and 6th month follow-up, systolic pulmonary arterial pressure, right atrial dimension and right ventricular diastolic diameter were found to be significantly lower than the preoperative values ( P < 0.0001). The right atrial diameter and tricuspid valve area had decreased significantly at the end of the 1st month; however, no significant difference was found between the 1st and 6th month tests ( P > 0.05). Three-quarters of the annuloplasty ring had degraded at 6 months. No complications related to the prosthesis or the procedure occurred within this period. Kalangos Biodegradable Ring is a promising prosthesis in patients with functional tricuspid insufficiency, with encouraging initial results.

Polydioxanone Polymers for Annuloplasty in Valve Repair

AbstractThe Kalangos biodegradable ring® was recently developed fpr mitral and tricuspid annuloplasty to allow for flexibility, remodeling and preservation of growth potential of the native annulus. In this article, the results of the experimental trials carried out to assess its safety and potential advantages will be discussed.

Mitral annuloplasty with biodegradable ring for infective endocarditis: a new tool for the surgeon for valve repair in childhood

The incidence of bacterial endocarditis and valvular involvement is rare in the childhood period. If the patient is unresponsive to medical treatment and some complications occur, early surgical treatment is indicated. Debridement of vegetation combined with valve repair techniques sparing the native valve is the ideal surgical procedure instead of replacement, especially for children. Annuloplasty is the key step during valve repair procedures. On the other hand, absence of appropriate sized annuloplasty rings on the market for this group of patients is the main problem. Nondegradable annuloplasty rings might lead to stenosis as the child grows. Thus, biodegradable tissue engineered materials are new solutions for such patients since the fibrous tissue induced by implanted ring grows with time. We describe a pediatric patient with Brucella endocarditis at the mitral position who was treated successfully with valve repair using a biodegradable annuloplasty ring (Kalangos Biodegradable Ring).