Semi-rigid Ring Research Articles

Closed-chest robotic mitral repair using a semi-rigid ring inserted through a trocar.

There are several types of annuloplasty devices for mitral repair. We present a totally-thoracoscopic robotic mitral repair using a new semi-rigid ring with a nitinol core that makes it malleable so that it can be inserted through a trocar. This technique combines the advantages of semi-rigid rings and a totally-thoracoscopic approach, which may further expand this approach to other aetiologies.

IATROGENIC ACUTE MITRAL INSUFFICIENCY FOLLOWING IMPELLA–ASSISTED INTERVENTIONAL PROCEDURE

Abstract Background Short–term left ventricle mechanical assistance device could be useful in assist interventional cardiologist during high–risk procedures. Abiomed Impella is one of the most frequently used device in this respect due to the high flow available with a low rate of reported complications. Here we report a rare but potentially catastrophic complication related to the Impella device. Case Description A 78 years old patient was referred to our Division by a peripheral hospital for a severe, symptomatic (NYHA III) mitral regurgitation (MR) due to posterior mitral leaflet prolapse (with focal eversion of P3) and chordal rupture (Fig 1a). Medical history included a previous admission in the some hospital due to a scheduled Impella–assisted PTCA (left main/left anterior descending artery) . Pre–procedural trans–thoracic ECHO (TTE) did not show significant MR (Fig 1b). Results Patient underwent urgent surgical procedure. At operation postero–medial mitral commissure was seen to be completely everted with multiple rupture of P3 and A3 chordae. Surgical procedure (Fig 1c) included: P3 plication + posterior–medial commissure edge–to–edge plasty + complete mitral semi–rigid ring (Simulus) n.30. Left atrial appendage was also closed using an external Atriclip. Postoperative course was without significant complications except a superficial wound dehiscence which delayed hospital discharge till 20th postoperative day. Conclusion Despite being a feasible and attractive option for short–term mechanical circulation assistance during high–risk interventional procedure, Impella device insertion could cause significant mitral valve damage leading to clinical deterioration. Such potentially catastrophic complication should be, therefore, mandatory excluded before patient discharge following interventional procedure.

Anomalous circumflex artery encircling the aortic annulus: implications for mitral valve repair

Injury to coronary arteries during mitral surgery is a rare but life-threatening procedural complication, an anomalous origin and course of the left circumflex artery (LCx) increase this risk. Recognizing the anomaly by the characteristic angiographic pattern and identifying its relationship with the surrounding anatomical structure using imaging techniques, mainly transesophageal echocardiography (TOE) or coronary computed tomography angiography (CCTA), is of crucial importance in setting up the best surgical strategy. We report a case of anomalous origin of a circumflex artery (LCx) from the proximal portion of the right coronary artery (RCA) with a pathway running retroaortically through the mitro-aortic space. An integrated diagnostic approach using a multidisciplinary team with a cardiologist and an imaging radiologist allowed us to decide the surgical strategy. We successfully performed a mitral valvular repair using a minimally invasive minithoracotomic approach and implanting a complete semirigid ring.

Management of Moderate Ischemic Mitral Regurgitation in Patients Undergoing Surgical Revascularization

Abstract Background Chronic ischemic mitral regurgitation (IMR) is not uncommonly seen in association with patients diagnosed with coronary artery disease and represents a late sequel of chronic myocardial ischemia and infarction. It adversely affects cardiovascular mortality and morbidity especially in patients undergoing coronary artery bypass grafting (CABG) surgery. We aim to identify the optimal management of moderate IMR in patients undergoing coronary artery bypass grafts surgery (CABG), whether to address this pathology during revascularization surgery or not. Methods 100 patients diagnosed with Ischemic Heart Disease (IHD) associated with moderate IMR undergoing Coronary Artery Bypass Grafting (CABG). Patients were divided into two equal groups according to their Mitral valve intervention: Group A; 50 Patients with IMR planned for complete revascularization only and Group B; 50 patients planed for revascularization combined with mitral valve surgery. The two groups were compared demographically, for intraoperative and post-operative events. The primary end point was hospital mortality, secondary end points included post-operative improvement in the NYHA functional class, improvement of EF % and reduction of LV dimensions in post-operative echocardiography and finally, the incidence of neurological dysfunction in both groups. Results All the patients in both groups underwent CABG surgery using cardiopulmonary bypass machine. Patients in group B underwent combined Mitral valve surgery in the form of; Mitral valve replacement using a mechanical valve in 7 patients, Mitral valve repair with downsizing annuloplasty surgery using complete semi-rigid ring in 43 patients, of which 13 patients required additional chordal repair with artificial chordea. Group (A) patients were found to have statistically significant shorter total bypass time 72.2± 17.6 vs 113.5± 14.3 (p < 0.001), ischemic time 47.4 min ± 12.1 vs 79.7 min ± 12.3 (p < 0.001), mechanical ventilation duration 10.9 hours ±14.9 vs 14.9 hours ±12.1 (p < 0.001), total period of ICU stay was 46.1 hours ±21.2 vs 63.7 hours ±22.2 and ward stay 5.7 days ±2.3 vs 6.8 days ±2.9 vs (p < 0.001) in group A vs group B respectively. Hospital mortality was insignificant between the 2 groups [(5 patients in group A (10%) vs 4 patients in group B (8%) P = 0.84)]. One month post-surgery, all survivors showed improvement of their ejection fraction and reduction in left ventricular and left atrial dimensions in Transthoracic echo however, there were no statistical significant improvement when comparing patients in both groups. Both groups showed similar improvement in Dyspnea score at one month follow up. Neurological insults were comparable in both groups (none vs one patient in group A vs B simultaneously. Conclusion Addition of mitral-valve surgery to CABG in patients with moderate degree of Ischemic Mitral regurgitation did not show significant benefit on survival, post-operative NYHA class of the patients, the echocardiographic findings or stroke incidence during the short term follow up. On the contrary, it resulted in longer durations of cardiopulmonary bypass, aortic cross-clamp time and longer ICU stay. Longer term follow-up is required to identify its potential benefit.

Mitral valve repair with the use of the “Memo 3D ReChord” ring

BackgroundFrom a variety of ring types, semirigid ring is more preferred for mitral annuloplasty during mitral valve repair particularly in patients whose native mitral saddle shape annulus is well maintained. During mitral annuloplasty artificial chord implantation with the appropriate neochord length is surgically challenging. We present our experience of using the Memo 3D ReChord, a semirigid ring with additional chordal guiding system for mitral valve repair.Patients and methodsFrom September 2018 to February 2020, we successfully treated ten patients with severe (4+/4+) degenerative mitral valve regurgitation due to posterior leaflet prolapse with chordal rupture with the implantation Memo 3D ReChord and neo-chords.ResultsWe implanted from one to three neo-chords and always a ring in our patients. None of the patients had any residual mitral valve regurgitation at the end of the repair and on their discharge evaluated through transesophageal and transthoracic echocardiography respectively. There was no mortality at 30-days or on midterm follow-up. During the 3-month follow-up no regurgitation was noticed either. We included in our study only the patients successfully treated. We also used it in two patients, who underwent valve replacement during the same operation due to mild to moderate mitral valve regurgitation.ConclusionsThis, in our knowledge, is the first Greek series of the implantation of the Memo 3D Rechord. The initial excellent results give us the enthusiasm to continue while long-term results and the durability of this technique are necessary to establish this semirigid annuloplastic ring in our every-day practice.

Anuloplastia de De Vega. Cincuenta años desde el comienzo de la reparación valvular selectiva, regulable y permanente

De Vega annuloplasty consists of a double suture supported by Teflon patches at its ends and tied in such a way as to correct regurgitation in the tricuspid valve. After 50 years since its publication, its historical background, the original technique and the successive modifications that have emerged under the same pathophysiological concept are reviewed. De Vega annuloplasty has been used extensively throughout the world to correct tricuspid insufficiency, especially secondary functional regurgitation concomitantly with mitral valve surgery. It has also been used in traumatic injuries, heart transplantation or the child population. Compared with annuloplasty with a rigid or semirigid ring, it seems to confer less stability over time, without this having translated into an increase in morbidity and mortality or in the rate of reinterventions. It is a fast, simple, reproducible, economical, safe technique that offers excellent clinical results in selected patients, and that after 50 years is still valid, especially as a treatment for non-severe functional tricuspid regurgitation in the context of left valve surgery without significant dilatation of the right ventricle.

Comparative analysis of mid-term outcomes of Rigid and NeoRing support rings in mitral regurgitation surgery: a prospective randomized trial

Highlights. For the first time, as part of a prospective randomized study, a comparative assessment of the mid-term results of mitral valve annuloplasty using a new biological NeoRing ring (CJSC NeoKor, Kemerovo) and a RIGID ring (CJSC NPP MedInzh, Penza) in patients with connective tissue dysplasia was carried out. Predictors of the conversion of sinus rhythm to atrial fibrillation and residual mitral insufficiency in the medium-term follow-up period were determined.Aim. To analysis and compare mid-term results of mitral valve annuloplasty conducted using NeoRing и RIGID rings.Methods. From November 2019 to March 2022, 62 patients with mitral valve (MV) dysplasia underwent MV annuloplasty using NeoRing semi-rigid rings (CJSC NeoKor, Kemerovo, n = 31) and rigid RIGID rings (CJSC NPP MedInzh, Penza, n = 31). There were no differences between the groups at baseline.Results. Two deaths were registered during inpatient treatment in the RIGID group. Both devices showed a satisfactory outcome during inpatient treatment in the form of restoration of MV function (p<0.001) and the frequency of detected maximum residual mitral regurgitation (MR) up to grade 1 in the NeoRing group 9.7% and in the RIGID group 29%, respectively, no statistically significant intergroup differences were noted (p = 0.292). After 12 months, freedom from ≥2 grade MR in the NeoRing group was 93.5% and 77.4% in the RIGID group (p = 0.147). In the RIGID group, patients had higher values of the transvalvular mitral diastolic gradient – PAV 3.70 [3.00–4.40] mm Hg vs. NeoRing group 2.3 [2.05–2.85] mmHg (p<0.001), as well as a higher transvalvular flow rate – VAV 79 [71–94] cm/sec vs. 70 [64–79] cm/sec (p = 0.017). The analysis of the achievement of composite primary endpoint (recurrence of ≥2 grade MR, MACCE, new onset arrhythmias, reoperations) by the device was carried out. The composite endpoint rate in the RIGID group was 3.067 times higher compared to the NeoRing group, odds differences were statistically significant (p = 0.037, 95% CI: 1.053–8.934).Conclusion. The outcome of MV annuloplasty conducted using rigid and semi-rigid rings revealed no significant differences in long-term survival and recurrence of MR between groups. Given the statistically significant difference in achieving the combined endpoint, lower inpatient and long-term indicators of transmitral pressure gradient, and a positive effect on cardiac chambers reverse remodeling, it was concluded that the use of semi-rigid NeoRing rings for MV annuloplasty when performing valvepreserving operations for connective tissue dysplasia is preferable.

Five Year Experience of Mitral Valve Repair Surgery at Armed Force Institute of Cardiology

Objective: Experience of the conventional and a de novo Mitral repair techniques for the treatment of Severe Mitral Regurgitation (MR) in a Tertiary Care Cardiac Hospital of Pakistan.
 Study Design: Descriptive cross sectional
 Place and Duration of Study: Cardiac Surgical Division, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, Pakistan
 Methodology: This was a cross sectional study conducted over a period of 5 years from 2016 to 2020, which included SeventyFive (n=75) patients in the trial, 55 females and 20 males. The mean age was 23±9.5 years (range from 16 to 52 years). Amongst all cases of mitral regurgitation (MR) were five (6%) myxomatous degenerative changes, three (4%) ischemic MR & Sixtyseven (91%) patients had rheumatic aetiology. Five (05) patients with myxomatous diseases required only ring annuloplasty. In patients with ischemic MR, two required chordal shortening for anterior leaflet resuspension, and one required quadrangular resection of the posterior leaflet. Restrictive annuloplasty±Coronary Artery Bypass Grafting (CABG) was alsoperformed as part of the procedures. Sixty-seven (91%) patients having severe Mitral Regurgitation with rheumatic aetiology, required a myriad of procedures; including neo-chordae suspension for anterior & posterior mitral leaflets, quadrangular resection & reattachment of the posterior mitral leaflet. A novel innovative procedure, “Posterior annulus-sliding-plasty” (Nasir’s Technique) was adopted in patients with relatively fixed posterior mitral leaflet. Semi-rigid rings (Carbomedics® or Medtronic CG future®) were used in all the patients to stabilize our repair.
 Results: There was no operative mortality. Patients were followed up for 01-year. Most of the patients have been found to have adequate intact Mitral Valve Repair. Only 01 patient developed Grade-II MR after 06 months (ischemic aetiology). This patient is being followed up at 06 monthly intervals with transthoracic echo and is being treated as per guideline-directed medical therapy (GMDT) for functional MR.
 Conclusion: Mitral Valve Repair in the carefully selected subset of patients with severe MR, irrespective of aetiology can effectively be treated with satisfactory short-term and medium-term results.

Ciddi restriksiyonu olan mitral anterior liflet için kordal ayırma

Functional mitral regurgitation (MR) is usually caused by cardiomyopathy. Herein, we present chordal cutting and ring annuloplasty due to severely restricted anterior leaflet. Seventy-seven years old, male patient suffering shortness of breath had the diagnosis of severe mitral regurgitation and coronary artery disease. Preoperative echocardiography showed reduced ejection fraction and severe central jet due to tethering of secondary chordae. Restricted chordae were resected by transverse aortotomy, saphenous graft bypass was done, and semi-rigid ring was implanted. Postoperative echocardiography showed no residual regurgitation, excellent mobility of anterior leaflet. Chordal cutting seems to be an effective technique to treat functional MR caused by the restriction of anterior leaflet

Mitral Repair With Complete Rings or Posterior Bands in Barlow Disease: Long-term Results

BackgroundComplete rings or posterior bands are both commonly used during mitral valve repair, but which one ensures the best long-term outcome in patients with Barlow disease is a topic of debate. This study evaluated whether the type of annuloplasty device affects the long-term durability of the repair. MethodsWe selected 296 consecutive patients with severe mitral regurgitation due to Barlow disease who underwent edge-to-edge mitral repair at our institution between 2004 and 2013. For the edge-to-edge repair, a complete semirigid ring was used in 151 patients, whereas a posterior flexible band was used in 145 patients. The clinical and echocardiographic outcomes of both groups were compared at long-term follow-up. ResultsAt 14 years, the overall survival was 87.3% ± 2.79% in the ring group and 94.1% ± 2.30% in the band group (P = .056). The incidence of mitral valve reintervention was 4.9% ± 1.95% in the ring group and 5.5% ± 2.53% in the band group (P = .371) at 14 years. The incidence of recurrence of mitral regurgitation ≥3+ and ≥2+ was 8.3% ± 2.64% in the ring group and 8.7% ± 3.07% in the band group (P = .991) and 26.5% ± 4.23% in the ring group and 17.4% ± 3.26% in the band group (P = .697), respectively. Mitral regurgitation ≥1+ at discharge was the only independent predictor of reoperation and recurrence of mitral regurgitation ≥3+ in the long-term. ConclusionsIn patients with Barlow disease undergoing edge-to-edge mitral valve repair, the type of annuloplasty device does not influence the long-term results. Achieving an optimal immediate result remains the key to maintain the stability of the repair at long-term.

Long-term results of tricuspid valve repair using three-dimensional versus flexible rings in patients with functional tricuspid regurgitation.

Significant functional tricuspid regurgitation (TR) should be corrected in patients undergoing surgery for left-sided valvular diseases. We hypothesized that ring type may affect outcomes in tricuspid annuloplasty. Herein, we report our experience with three-dimensional semi-rigid rings compared to open simple-band annuloplasty. This is a retrospective study that included all patients who underwent tricuspid annuloplasty concomitant to left-sided valvular surgery. The study's main outcome measure was long-term recurrent TR probability. Of the 781 study patients, 611 (78%) underwent annuloplasty using flexible band and 170 (22%) underwent rigid ring implantation. Early mortality did not differ significantly between the rigid and flexible groups (4.4% vs 4.1%, P = 1.000). Long-term mortality was similar between the groups [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.69-1.36, P = 0.847]. At a mean follow-up of 62 (50) months, freedom from TR grade 3+/4+ was 96.4% and 96.7% in the rigid and flexible groups, respectively (HR 1.41, 95% CI 0.55-3.61, P = 0.476). Furthermore, 2.4% of the rigid and 1.3% of the flexible groups required reoperation (HR 1.01, 95% CI 0.21-4.82, P = 0.988). Multivariable analysis demonstrated that rheumatic valve aetiology (HR 1.92, CI 1.04-2.98, P = 0.042) and mitral stenosis (HR 1.44, CI 1.01-2.2, P = 0.044) were predictors for recurrent TR (3+/4+). Ring type was not associated with recurrence (HR 0.86, 95% CI 0.3-2.47, P = 0.787). Open bands performed at least as well as three-dimensional rings. Our results suggest that late clinical results of tricuspid annuloplasty depend on left-sided pathology and patient factors and less on the type of ring used.

Chain Alignment of a Rigid Ring Polymer in the Lyotropic Liquid Crystal Phase: Cyclic Amylose Tris(n-butylcarbamate) in Tetrahydrofuran and Ethyl Lactate

Concentrated solutions of a rigid ring polymer, cyclic amylose tris(n-butylcarbamate) (cATBC), have lyotropic liquid crystallinity. Phase boundary concentrations of cATBC in tetrahydrofuran (THF) and l-ethyl lactate (EL) were almost identical to those for the linear polymer (ATBC) with the same molar mass. X-ray diffraction for the concentrated cATBC solutions revealed that nematic phases were found for cATBC in the two solvents, while the cholesteric structure was observed for the cATBC–EL system. Several peaks were found in the high q range between 3 and 10 nm–1 with q being the magnitude of the scattering vector. The obtained patterns were almost the same as that for an ATBC sample in the corresponding solvent, indicating that the local alignment of the polymer chains is similar between the ring and linear polymers. This result strongly suggests that cATBC chains in concentrated solutions form a pseudo-rodlike conformation with two kinks, whereas cATBC chains behave as semirigid rings in dilute solution. The phase diagram can be also explained in terms of the known theory for the wormlike cylinder, assuming the pseudo-rodlike conformation.

Buckling of square and hexagonal semi-rigid rings by concentrated loads

This paper studies rings with rigid segments and rotationally flexible joints under compressive forces. Using geometry and symmetry, exact closed-form expressions for the buckling forces are found. Depending on how the forces are applied, the ring may not buckle at all, or may buckle with a regular pitchfork bifurcation, or may have nonlinear snap-through and hysteresis characteristics. The latter defines a global buckling load below which the ring is stable under any finite disturbances. The buckling properties of the square and hexagonal rings are important since they serve as unit cells for larger structures such as honeycomb, graphene and tensegrity structures.

The best approach for functional tricuspid regurgitation: A network meta-analysis.

For many years, functional tricuspid regurgitation (FTR) was considered negligible after treatment of left-sided heart valve surgery. The aim of the present network meta-analysis is to summarize the results of four approaches to establish the possible gold standard. A systematic search was performed to identify all publications reporting the outcomes of four approaches for FTR, not tricuspid annuloplasty (no TA), suture annuloplasty (SA), flexible (FRA), rigid rings (RRA). All studies reporting at least one the four endpoints (early and late mortality, early and late moderate or more TFR) were included in a Bayesian network meta-analysis. There were 31 included studies with 9663 patients. Aggregate early mortality was 5.3% no TA, 7.2% SA, 6.6% FRA, and 6.4% RRA; early TR moderate-or-more was 9.6%, 4.8%, 4.6%, and 3.8%; late mortality was 22.5%, 18.2%, 11.9%, and 11.9%; late TR moderate-or-more was 27.9%, 18.3%, 14.3%, and 6.4%. Rigid or semirigid ring annuloplasty was the most effective approach for decreasing the risk of late moderate or more FTR (-85% vs. no TA; -64% vs. SA; -32% vs. FRA). Concerning late mortality, no significant differences were found among different surgical approaches; however, flexible or rigid rings reduced significantly the risk of late mortality (78% and 47%, respectively) compared with not performing TA mortality. No differences were found for early outcomes. Ring annuloplasty seems to offer better late outcomes compare to either suture annuloplasty or not performing TA. In particular rigid or semirigid rings provide more stable FTR across time.

Long-Term Results of Mitral Repair With Complete Semi-Rigid Rings vs Posterior Flexible Bands

The aim of the study was to evaluate whether the type of ring used had an impact on the long-term results of mitral repair for degenerative mitral regurgitation (MR), due to posterior leaflet prolapse, treated with quadrangular or triangular resection. From January 2002 to December 2008, 1406 patients with severe MR due to posterior leaflet prolapse underwent mitral repair. Of these patients, we selected 452 consecutive patients treated with the same repair approach. Mitral annuloplasty to complete the repair was performed with a posterior flexible band (n= 260) or a complete semi-rigid ring (n= 192). The 2 groups were comparable at baseline, and their clinical and echocardiographic outcomes were compared at long-term follow-up. Overall survival at 14 years was similar (P= .29). The cumulative incidence function of cardiac death, with noncardiac death as competing risk, showed no difference (P= .71). At 14 years, probability of recurrence of MR greater than or equal to 3+ was 1.11% in the flexible band group and 3.25% in the semi-rigid ring group (P= .073). At 14 years, probability of recurrence of MR greater than or equal to 2 was 13.49% in the band group vs 10.78% in the semi-rigid ring group (P= .897). In patients requiring mitral valve repair for posterior leaflet prolapse, treated with the same repair approach, the type of annuloplasty ring has no impact on the incidence of cardiac death and recurrence of MR at 14 years. Whether these findings remain stable at longer follow-up should be further investigated.

P1531 Changes in mitral annular dynamics with three different types of annuloplasty devices: measurement using three-dimensional transoesophageal echocardiography

Abstract OnBehalf National Cerebral and Cardiovascular Center, Japan Background/Purpose Mitral annuloplasty plays a crucial role during mitral valve (MV) repair. The dynamics of the mitral annulus (MA) may be variously affected by the annuloplasty device. Therefore, we investigated the differences in MA dynamics when using a semi-rigid ring, semi-rigid band, and flexible ring. Methods We retrospectively reviewed 61 patients with mitral regurgitation who underwent MV repair, which included annuloplasty. Semi-rigid rings were used in 33 patients, flexible bands in 21, and semi-rigid bands in seven. Three-dimensional transoesophageal echocardiography (3D-TEE) images of the MV were recorded before and after annuloplasty. The 3D-TEE image datasets were analysed using semi-automated analysis software. We measured anterolateral–posteromedial (AL–PM) and anteroposterior (AP) diameter and height of the MV. The sphericity index (AP diameter divided by AL-PM diameter) and annular height to commissural width ratio (AHCWR) were calculated as the circular and saddle-shaped geometries, respectively. The differences in these values between end diastole (ED) and end systole (ES) were compared by t-test before and after mitral annuloplasty to analyse the MA among the semi-rigid ring, semi-rigid band, and flexible ring. Results Before annuloplasty (n = 61), the AL–PM diameter was significantly larger (ED: 4.26 ± 0.08 vs. ES: 4.24 ± 0.07, p = 0.016) and the sphericity index was significantly smaller (ED: 0.93 ± 0.01 vs. ES: 0.94 ± 0.01, p = 0.017) at ED than at ES. Table 1 shows the analysis after annuloplasty for each device. After annuloplasty, not every group demonstrated significant differences in AL–PM diameter or sphericity index. MA dynamics were reduced equally with the three devices. Conclusion Mitral annuloplasty reduced MA dynamics equally when using a semi-rigid ring, semi-rigid band, and flexible ring. There were no distinctive differences among the three devices in terms of maintaining flexibility and a saddle-shaped geometry. MV dynamics after mitral annuloplasty Semi-rigid ring (n = 33) Flexible band (n = 21) Semi-rigid band (n = 7) ES ED P value ES ED P value ES ED P value AP (cm) 2.61 ± 0.38 2.67 ± 0.44 0.15 2.61 ± 0.38 2.67 ± 0.44 0.15 2.79 ± 0.44 2.80 ± 0.43 0.75 AL-PM (cm) 2.85 ± 0.31 2.91 ± 0.39 0.20 2.85 ± 0.31 2.91 ± 0.39 0.20 2.70 ± 0.39 2.73 ± 0.42 0.15 Height (cm) 0.49 ± 0.20 0.51 ± 0.21 0.35 0.63 ± 0.17 0.62 ± 0.17 0.48 0.63 ± 0.13 0.63 ± 0.13 1.00 SI 0.92 ± 0.09 0.92 ± 0.09 0.45 0.91 ± 0.09 0.91 ± 0.08 0.85 0.95 ± 0.12 0.95 ± 0.11 0.34 AHCWR(%) 17.1 ± 6.65 17.4 ± 6.67 0.56 20.4 ± 5.00 20.2 ± 5.10 0.52 21.3 ± 4.49 21.3 ± 4.80 0.95 Data are expressed mean ± standard deviation. AP: anterior posterior; AL-PM: anterolateral-posteromedial; SI: Sphericity index; AHCWR: annular height to commissure width ratio; ES: endsystole; ED: enddiastole. Abstract P1531 Figure

Restrictive mitral valve annuloplasty for chronic ischaemic mitral regurgitation: outcomes of flexible versus semi-rigid rings.

Restrictive mitral annuloplasty is the mainstay of surgical correction of chronic ischaemic mitral regurgitation (CIMR). Long-term data on the various types of annuloplasty rings is limited. The aim of this study was to investigate the clinical and echocardiographic outcomes of restrictive mitral annuloplasty in patients with CIMR, comparing the use of flexible versus semi-rigid annuloplasty rings. A retrospective review was conducted for 133 patients with CIMR who underwent restrictive mitral annuloplasty at our institution between 1999 and 2015. Patient demographics and postoperative outcomes were analyzed. Mean age was 61.9±9.2 years and 103 patients (77.4%) were male. All patients underwent coronary artery bypass grafting, with a mean of 3.3±0.8 grafts. Flexible rings was implanted in 39 patients (29.3%, group F) and semi-rigid rings in 94 (70.7%, group R). Preoperative New York Heart Association class was III/IV in 104 patients (78.2%). Mean preoperative left ventricular ejection fraction was 28.8%±10.2%. Preoperative mitral regurgitation was moderate in 51 patients (38.3%) and severe in 82 (61.7%). In-hospital mortality occurred in 11 patients (8.3%). Overall survival at 1, 5 and 10 years were, respectively, 86.4%, 69.7% and 45.9%. At 10 years, overall survival (group F 53.1%, group R 40.0%, P=0.330) and freedom from moderate to severe MR (group F 53.1%, group R 53.8%, P=0.725) did not differ significantly. Freedom from hospitalization for heart failure was 59.3%. Left ventricular reverse remodelling, defined as a reduction of left ventricular end-systolic volume index >15%, occurred more commonly in Group R (51.1%) compared to Group F (23.1%), P=0.003. Restrictive mitral annuloplasty was associated with an operative mortality of 8.3%. Heart failure symptoms and significant MR recur in approximately 40% of patients after 10 years. Survival remained suboptimal and was not influenced by the type of annuloplasty ring.

Mid-term outcomes of simultaneous mitral valve repair in patients with miral regurgitation and concomitant annulo-aortic ectasia.

This study investigated the mid-term outcomes of simultaneous mitral valve repair in patients with mitral regurgitation (MR) and concomitant annulo-aortic ectasia. The study included 26 patients with MR and annulo-aortic ectasia [mean age 46.0 ± 19.9 (10-86) years] who underwent simultaneous mitral valve repair between January 2007 and March 2018. Of these 26 patients, 11 (42.3%) were diagnosed with Marfan syndrome and 10 (38.5%) with Barlow's disease. All patients underwent complete ring annuloplasty; a semi-rigid ring was used in 14 (53.8%) and a semi-flexible ring (anterior-flexible) in 12 patients (46.2%). All patients underwent valve-sparing root replacement using the reimplantation technique. The overall 3-year survival rate was 95.7 ± 4.3%. The 3-year freedom from > moderate MR rate was 94.7 ± 5.1%, and the 3-year freedom from > moderate aortic regurgitation (AR) rate was 86.7 ± 7.3%. The 3-year freedom from reoperation rate was 100%. The 3-year freedom from > moderate MR rate was 100% in the semi-rigid ring group and 85.7 ± 13.2% in the semi-flexible ring group (log-rank test, p = 0.5371). The 3-year freedom from > moderate AR rate was 100% in the semi-rigid ring group and 72.9 ± 16.5% in the semi-flexible ring group (log-rank test, p = 0.0815). Simultaneous mitral valve repair in patients with MR and concomitant annulo-aortic ectasia showed favorable mid-term outcomes.

Long-Term Outcomes Of Mitral Valve Repair Using A Small Semi-Rigid Ring

Objective: A small semi-rigid ring may be a good option in mitral annuloplasty although it has a risk of functional mitral stenosis. We assesssed early and long-term clinical outcomes of mitral val...

EP02 A FOCUSED APPROACH CAN VIRTUALLY ELIMINATE THE INCIDENCE OF SYSTOLIC ANTERIOR MOTION AFTER MITRAL VALVE REPAIR

Abstract Objective(s): The incidence of systolic anterior motion(SAM) after mitral valve repair(MVRr) varies between 4 and 10% of cases. The combination of a small left ventricle(<45 mm), a high posterior leaflet(>15 mm), a narrow aorto-mitral angle(<120°), a narrow coaptation-septal distance(<25 mm) or an enlarged basal septum (≥15 mm) significantly increases the risk for SAM. Aim of this study was to evaluate the incidence of SAM in patients with a combination of at least two of these risk factors and report their echocardiographic/clinical outcomes. Methods: Between 2007 and 2014, 165 patients underwent MVRr for degenerative disease using classic Carpentier techniques. The annuloplasty was performed with a complete semi-rigid ring chosen using only the maximal height of the anterior leaflet as a reference. Preoperative echocardiography identified patients at intermediate risk(one risk factor only) or high risk(2 or more risk factors) for SAM. Results: Of these 165 patients, 22(13.3%) had an intermediate risk for SAM and 35(21.2%) a high risk. During the study period, we did not find any case of SAM, neither in the low risk group nor in the high risk group. At a median follow-up of 3.9 years, the survival did not differ among patients with no, intermediate or high risk of SAM(p = 0.6). Freedom from more than moderate mitral regurgitation at 4 years was also similar(no risk = 92.9%, low risk = 100% and high risk = 97.9%, p = 0.8). Conclusions: Even in patients with high risk of SAM, the incidence of this complication can be eliminated using a focused approach on annuloplasty ring sizing and posterior leaflet height.