Subscribe to RSS
DOI: 10.1055/s-0039-1696989
Functional and Degenerative Mitral Regurgitation: One Ring Fits All?
Funding This study was supported by Medtronic. The funding supported echocardiography facilities and research staff.
Abstract
Background Three-dimensional saddle-shaped annuloplasty rings have been shown to create a larger surface of leaflet coaptation in mitral valve repair (MVR) for functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR) which may increase repair durability. For the first time, this study reports mid-term results after MVR for DMR and FMR using a rigid three-dimensional ring (Profile 3D, Medtronic).
Methods Between June 2009 and June 2012, 369 patients with DMR (n = 326) or FMR (n = 43) underwent MVR (mean age 62.3 ± 12.6 years). A total of 205 patients (55.6%) underwent isolated MVR and 164 patients (44.4%) a combined procedure. Follow-up examinations were performed in 94.9% (mean 4.9 ± 0.9 years). Echocardiographic assessment was complete in 93.2% (mean 4.3 ± 1.2 years).
Results The 30-day mortality was 1.5% (5/326) for DMR (1.5% for isolated and 1.6% for combined procedures) and 9.3% (4/43) for FMR (0% for isolated and 10.5% for combined procedures). Survival at 6 years was 92.1 ± 1.9% for DMR (92.9 ± 2.6% for isolated and 90.7 ± 2.7% for combined procedures) and 66.4 ± 7.9% for FMR (80.0 ± 17.9% for isolated and 63.7 ± 8.9% for combined procedures). Cumulative risk for mitral valve-related reoperation at 6 years was 0% for FMR and 7.1 ± 1.5% for DMR. At echocardiographic follow-up, one patient presented with mitral regurgitation (MR) more than moderate. The only predictor of recurrent MR after MVR for DMR was residual mild MR at discharge.
Conclusion Repair of FMR with the three-dimensional Profile 3D annuloplasty ring shows excellent mid-term results with regard to recurrence of MR. In cases of DMR, the results are conforming to the current literature.
Meeting Presentation
This study was presented at the 46th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery (DGTHG), Leipzig, February 11–14, 2017.
Disclaimer
The German Society for Thoracic and Cardiovascular Surgery (DGTHG) and the Thoracic and Cardiovascular Surgeon neither endorse nor discourage the use of the product described in this publication.
Publication History
Received: 01 March 2019
Accepted: 05 August 2019
Article published online:
23 September 2019
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
-
References
- 1 Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet 2009; 373 (9672): 1382-1394
- 2 Carpentier A. Cardiac valve surgery--the “French correction”. J Thorac Cardiovasc Surg 1983; 86 (03) 323-337
- 3 Nishimura RA, Otto CM, Bonow RO. , et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135 (25) e1159-e1195
- 4 Vahanian A, Alfieri O, Andreotti F. , et al; ESC Committee for Practice Guidelines (CPG); Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2012; 42 (04) S1-S44
- 5 Goldstein D, Moskowitz AJ, Gelijns AC. , et al; CTSN. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med 2016; 374 (04) 344-353
- 6 Campisi S, Fuzellier JF, Haber B, Favre JP, Gerbay A, Vola M. Mid-term results of mitral valve repair for ischemic mitral regurgitation with ETlogix ring: a single-center study. Int J Cardiol 2016; 222: 924-930
- 7 Carpentier AF, Lessana A, Relland JY. , et al. The “physio-ring”: an advanced concept in mitral valve annuloplasty. Ann Thorac Surg 1995; 60 (05) 1177-1185 , discussion 1185–1186
- 8 Lange R, Guenther T, Kiefer B. , et al. Mitral valve repair with the new semirigid partial Colvin-Galloway Future annuloplasty band. J Thorac Cardiovasc Surg 2008; 135 (05) 1087-1093 , 1093.e1–1093.e4
- 9 Bouma W, Aoki C, Vergnat M. , et al. Saddle-shaped annuloplasty improves leaflet coaptation in repair for ischemic mitral regurgitation. Ann Thorac Surg 2015; 100 (04) 1360-1366
- 10 Vergnat M, Jackson BM, Cheung AT. , et al. Saddle-shape annuloplasty increases mitral leaflet coaptation after repair for flail posterior leaflet. Ann Thorac Surg 2011; 92 (03) 797-803
- 11 Jensen MO, Jensen H, Levine RA. , et al. Saddle-shaped mitral valve annuloplasty rings improve leaflet coaptation geometry. J Thorac Cardiovasc Surg 2011; 142 (03) 697-703
- 12 Mahmood F, Gorman III JH, Subramaniam B. , et al. Changes in mitral valve annular geometry after repair: saddle-shaped versus flat annuloplasty rings. Ann Thorac Surg 2010; 90 (04) 1212-1220
- 13 Jimenez JH, Soerensen DD, He Z, He S, Yoganathan AP. Effects of a saddle shaped annulus on mitral valve function and chordal force distribution: an in vitro study. Ann Biomed Eng 2003; 31 (10) 1171-1181
- 14 Guenzinger R, Guenther T, Ratschiller T. , et al. Is a profiled annuloplasty ring suitable for repair of degenerative mitral regurgitation? A single-center experience comprising 200 patients. Thorac Cardiovasc Surg 2016; 64 (05) 434-440
- 15 Zoghbi WA, Enriquez-Sarano M, Foster E. , et al; American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16 (07) 777-802
- 16 Doll N, Sheytanov V, Labrousse L. , et al. Clinical performance of a three-dimensional saddle-shaped, rigid ring for mitral valve repair. Eur J Cardiothorac Surg 2019; 55 (02) 217-223
- 17 Medtronic Inc. Profile 3D™ 680R Annuloplasty Ring Instructions for Use. Available at manuals.medtronic.com
- 18 Edmunds Jr LH, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. The American Association for Thoracic Surgery, Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Ann Thorac Surg 1996; 62 (03) 932-935
- 19 Rossi A, Dini FL, Faggiano P. , et al. Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy. Heart 2011; 97 (20) 1675-1680
- 20 Guenzinger R, Schneider EP, Guenther T. , et al. Three-dimensional valve repair-the better care? Midterm results of a saddle-shaped, rigid annuloplasty ring in patients with ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2014; 148 (01) 176-182
- 21 McGee EC, Gillinov AM, Blackstone EH. , et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2004; 128 (06) 916-924
- 22 De Bonis M, Lapenna E, Barili F. , et al. Long-term results of mitral repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation: does the technique matter?. Eur J Cardiothorac Surg 2016; 50 (05) 882-889
- 23 Giannini C, Fiorelli F, De Carlo M. , et al. Comparison of percutaneous mitral valve repair versus conservative treatment in severe functional mitral regurgitation. Am J Cardiol 2016; 117 (02) 271-277
- 24 Glower DD, Kar S, Trento A. , et al. Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study. J Am Coll Cardiol 2014; 64 (02) 172-181
- 25 Harmel EK, Reichenspurner H, Girdauskas E. Subannular reconstruction in secondary mitral regurgitation: a meta-analysis. Heart 2018; 104 (21) 1783-1790
- 26 David TE, Armstrong S, McCrindle BW, Manlhiot C. Late outcomes of mitral valve repair for mitral regurgitation due to degenerative disease. Circulation 2013; 127 (14) 1485-1492
- 27 Castillo JG, Anyanwu AC, El-Eshmawi A, Adams DH. All anterior and bileaflet mitral valve prolapses are repairable in the modern era of reconstructive surgery. Eur J Cardiothorac Surg 2014; 45 (01) 139-145 , discussion 145
- 28 Goldstone AB, Cohen JE, Howard JL. , et al. A “repair-all” strategy for degenerative mitral valve disease safely minimizes unnecessary replacement. Ann Thorac Surg 2015; 99 (06) 1983-1990 , discussion 1990–1991
- 29 Coutinho GF, Correia PM, Branco C, Antunes MJ. Long-term results of mitral valve surgery for degenerative anterior leaflet or bileaflet prolapse: analysis of negative factors for repair, early and late failures, and survival. Eur J Cardiothorac Surg 2016; 50 (01) 66-74
- 30 Suri RM, Clavel MA, Schaff HV. , et al. Effect of recurrent mitral regurgitation following degenerative mitral valve repair: long-term analysis of competing outcomes. J Am Coll Cardiol 2016; 67 (05) 488-498
- 31 Wang J, Han J, Li Y. , et al. Preoperative risk factors of medium-term mitral valve repair outcome. Interact Cardiovasc Thorac Surg 2014; 19 (06) 946-954
- 32 Varghese R, Itagaki S, Anyanwu AC, Trigo P, Fischer G, Adams DH. Predicting systolic anterior motion after mitral valve reconstruction: using intraoperative transoesophageal echocardiography to identify those at greatest risk. Eur J Cardiothorac Surg 2014; 45 (01) 132-137 , discussion 137–138