Relation of Annuloplasty Ring Size to the Body Surface Leads to Reduced Mean Pressure Gradients after Mitral Valve Repair

Background: Mitral valve repair is performed with an annuloplasty ring to create a durable coaptation area. Occasionally patients are postoperatively encountered with elevated mitral pressure gradients after mitral valve repair, despite the use of a “truesized” ring based on the anterior leaflet dimension (Doi et al, 2015). The aim of this study was to determine the minimum annuloplasty ring size as a function of the patient’s body surface area.

Methods: A total of 1,424 patients who underwent mitral valve repair at the HDZ-NRW, Bad Oeynhausen, were investigated between 2009 and 2016. Data such as gender, date of birth, age, height, and body weight of the patients as well as the duration of the operation, the ring size used, and the postoperative mean pressure gradient (MPG) values were analyzed. The Body Surface Area (BSA) of the patient relevant for the present study was derived from the patient’s body height and weight. Postoperative MPG values were correlated to the patient’s BSA and the ring sizes used were evaluated statistically.

Results: Annuloplasty rings too small in relation to the patient’s BSA led to significantly increased postoperative mean pressure gradients (MPGs). In this study, a BSA-dependent minimum ring size dmin could be determined for reducing the postoperative MPG by at least 10%. Significant differences were found between “too small” annuloplasty ring sizes and the minimum recommended ring size dmin. The minimum ring sizes to be used are summarized in [Table 1].

Table 1

BSA (m2)	Ring size dmin (mm)
1.45–1.54	28
1.55–1.74	30
1.75–1.84	32
1.85–2.24	34
2.25–2.44	36

Conclusion: Our study suggests preoperative determination of the minimum annuloplasty ring size to be used in mitral valve repair for each patient to reduce the postoperative MPG and improve hemodynamics. This may be a helpful tool to reduce to optimize postoperative mitral valve gradients and the potential risk of a postoperative mitral valve stenosis.

Publication History

Article published online:
11 February 2025