Cor Vasa 2020, 62(1):37-43 | DOI: 10.33678/cor.2020.003

A second look at autopericardial mitral annuloplasty

Abubakari I. Sidikia, Alexandr G. Faybushevichb, Alexandr N. Lishchukc
a Department of Cardiothoracic Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia
b Department of Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia
c Cardiovascular Center, FSBI 3 Central Vishnevsky Hospital, Moscow, Russia

Objective: To compare total pericardial mitral annuloplasty (PeMA) and total prosthetic mitral annuloplasty (PrMA) in terms of durability in the treatment of degenerative, ischemic functional and non-ischemic functional mitral regurgitation (MR).

Methods: We retrospectively reviewed prospectively collected data of 280 patients who received either PeMA (50.4%) or PrMA (with Carpentier-Edwards Physio rings; 49.6%) after valvuloplasty between 2008 and 2015. Combined procedures included: 40 CABG (PeMA - 18, PrMA - 22); 13 ablations with left atrial appendectomy (PrMA - 8, PrMA - 5); 7 tricuspid valve repairs (PeMA - 2, PrMA - 5); 9 closures of atrial septal defect (PeMA - 3, PrMA - 6).

Results: Thirty-day mortality was 0.4%. Mean follow-up was 95.7% complete at 83.4 ± 13.0 months. The procedures were comparable in terms of 7 years: Freedom from reoperation and recurrent MR = 2+/3+ (PeMA - 96.3%; PrMA - 96.4%; p = 0.914); freedom from complications (PeMA - 86.5%; PrMA - 89.2%; p = 0.174); survival (PeMA - 96.5%; PrMA - 97.8%; p = 0.238). Overall 7-year survival was 97.1%. Old-age and concomitant CAD were significant predictors of reoperation and recurrent MR = 2+/3+ (p = 0.027; HR = 1.131 and p = 0.030; HR = 2.002 respectively) and independent predictive factors for poor survival (p = 0.029; HR = 4.251 and p = 0.040; HR = 1.135 respectively) by multivariate analysis. High preoperative LVEF was independently related to a lower risk of reoperation and recurrence of MR = 2+/3+ (p = 0.006; HR = 0.786) and better survival (p = 0.013; HR = 0.718) by multivariate analysis.

Conclusions: With a reliable valvuloplasty, pericardial ring can be as durable as Physio ring and possibly surpass it with better methods of fixation. Cost-wise, pericardial ring is a better choice as it's free whilst Physio ring costs about $600. Prosthetic rings are not always associated with endocarditis, thromboembolism, valve calcification or hemolytic anemia.

Keywords: Autopericardium, Mitral valve failure, Mitral valve repair, Prosthetic ring

Received: December 13, 2019; Revised: December 13, 2019; Accepted: January 9, 2020; Published: February 28, 2020  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Sidiki AI, Faybushevich AG, Lishchuk AN. A second look at autopericardial mitral annuloplasty. Cor Vasa. 2020;62(1):37-43. doi: 10.33678/cor.2020.003.
Download citation

References

  1. Goldman M, Mora F, Guarino T, et al. Mitral valvuloplasty is superior to mitral valve replacement for preservation of left ventricular function: an intraoperative two dimensional echocardiographic study. J Am Coll Cardiol 1987;10:568-575. Go to original source... Go to PubMed...
  2. David T, Burns R, Bacchus C, et al. Mitral regurgitation with and without preservation of chordae tendinae. J Thorac Cardiovasc Surg 1984;88:718-725. Go to original source...
  3. Carpentier A, Chauvaud S, Fabiani JN, et al. Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg 1980;79:338-348. Go to original source...
  4. Edmunds LH, Clark RE, Cohn LH, et al. Guidelines for reporting morbidity and mortality after cardiac valvular operations. J Thorac Cardiovasc Surg 1996;112:708-711. Go to original source... Go to PubMed...
  5. Naik MM, Diamond GA, Pai T, et al. Correspondence of left ventricular ejection fraction determinations from two-dimensional echocardiography, radionuclide angiography and contrast cineangiography. J Am Coll Cardiol 1995;25:937-942. Go to original source... Go to PubMed...
  6. Maslow AD, Regan MM, Haering JM, et al. Echocardiographic predictors of left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve after mitral valve reconstruction for myxomatous valve disease. J Am Coll Cardiol 1999;34:2096-2104. Go to original source... Go to PubMed...
  7. Bevilacqua S, Cerillo AG, Gianetti J, et al. Mitral valve repair for degenerative disease: is pericardial posterior annuloplasty a durable option? Eur J Cardiothorac Surg 2003;23:552-559. Go to original source... Go to PubMed...
  8. Chauvaud S, Fuzellier JF, Berrebi A, et al. Long term (29 years) results of reconstructive surgery in rheumatic mitral valve insufficiency. Circulation 2001;104:I12-I15. Go to original source... Go to PubMed...
  9. Lorusso R, Borghetti V, Totaro P, et al. The double-orifice technique for mitral valve reconstruction: predictors of postoperative outcome. Eur J Cardiothorac Surg 2001;20:583-589. Go to original source... Go to PubMed...
  10. David TE, Armstrong S, Sun Z, Daniel L. Late results of mitral valve repair for mitral regurgitation due to degenerative disease. Ann Thorac Surg 1993;56:7-14. Go to original source... Go to PubMed...
  11. Cohn LH, Couper GS, Aranki SF, et al. Long-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve. J Thorac Cardiovasc Surg 1994;107:143-151. Go to original source...
  12. Nielsen SL, Timek TA, Lai DT, et al. Edge-to-edge mitral repair: tension on the approximating suture and leaflet deformation during acute ischemic mitral regurgitation in the ovine heart. Circulation 2001;104:I29-I35. Go to original source...
  13. Fedak PW, McCarthy PM, Bonow RO. Evolving concepts and technologies in mitral valve repair. Circulation 2008;117:963-974. Go to original source... Go to PubMed...
  14. Tibayan FA, Rodriguez F, Langer F, et al. Annular remodeling in chronic ischemic mitral regurgitation: ring selection implications. Ann Thorac Surg 2003;76:1549-1554. Go to original source... Go to PubMed...
  15. Salati M, Scorfani R, Santoli C. Posterior pericardial annuloplasty: a physiologic correction? Eur J Cardiothorac Surg 1991;5:226-229. Go to original source... Go to PubMed...
  16. Scrofani R, Moriggia S, Salati M, et al. Mitral valve remodeling: long-term results with posterior pericardial annulolasty. Ann Thorac Surg 1996;61:895-899. Go to original source... Go to PubMed...
  17. Borghetti V, Campana M, Scotti C, et al. Biological versus prosthetic ring in mitral-valve repair: enhancement of mitral annulus dynamics and left-ventricular function with pericardial annuloplasty at long term. Eur J Cardiothorac Surg 2000;17:431-439. Go to original source... Go to PubMed...
  18. Lorusso R, Borghetti V, Totaro P, et al. The double-orifice technique for mitral valve reconstruction: predictors of postoperative outcome. Eur J Cardiothorac Surg 2001;20:583-589. Go to original source... Go to PubMed...
  19. Gillinov AM, Blackstone EH, White J, et al. Durability of combined aortic and mitral valve repair. Ann Thorac Surg 2001;72:20-27. Go to original source... Go to PubMed...
  20. Stefano B, Alfredo GC, Jacopo G, et al. Mitral valve repair for degenerative disease: is pericardial posterior annuloplasty a durable option? Eur J Cardiothorac Surg 2003;23:552-559. Go to original source... Go to PubMed...
  21. Roberto S, Stefano M, Maurizio S, et al. Mitral valve remodeling: Long-term results with posterior pericardial annuloplasty. Ann Thorac Surg 1996;61:895-899. Go to original source... Go to PubMed...
  22. Zhu F, Otsuji Y,Yotsumoto G, et al. Mechanism of persistent ischemic mitral regurgitation after annuloplasty: importance of augmented posterior mitral leaflet tethering. Circulation 2005;112:I-396-I-401. Go to original source...
  23. Obarski TP, Loop FD, Cosgrove DM, et al. Frequency of acute myocardial infarction in valve repairs versus valve replacement for pure mitral regurgitation. Am J Cardiol 1990;65:887-890. Go to original source... Go to PubMed...
  24. Aybek T, Risteski P, Miskovic A, et al. Seven years' experience with suture annuloplasty for mitral valve repair. J Thorac Cardiovasc Surg 2006;131:99-106. Go to original source... Go to PubMed...
  25. Lorusso R, Borghetti V, Totaro P, et al. The double-orifice technique for mitral valve reconstruction: predictors of postoperative outcome. Eur J Cardiothorac Surg 2001;20:583-589. Go to original source... Go to PubMed...
  26. Sidiki AI, Lishchuk AN, et al. A comparison of pericardial and prosthetic annuloplasty in mitral valve repair. J New Med Technologies 2020;14:1-4.
  27. Rassi Jr A, Crawford MH, Richards KL, Miller JF. Differing mechanisms of exercise flow augmentation at the mitral and aortic valves. Circulation 1988;77:543-551. Go to original source... Go to PubMed...
  28. Valentino B, Marco C, Carla S, et al. Biological versus prosthetic ring in mitral-valve repair: enhancement of mitral annulus dynamics and left-ventricular function with pericardial annuloplasty at long term. Eur J Cardiothorac Surg 2000;17:431-439. Go to original source... Go to PubMed...
  29. Gillinov AM, Cosgrove DM, Blackstone EH, et al. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg 1998;116:734-743. Go to original source... Go to PubMed...
  30. Chauvaud SM, Deleuze P, Perier PM, Carpentier AF. Failures in reconstructive mitral valve surgery. Circulation 1986;74(Pt 2):I97-I105.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.





Cor et Vasa

You are accessing a site intended for medical professionals, not the lay public. The site may also contain information that is intended only for persons authorized to prescribe and dispense medicinal products for human use.

I therefore confirm that I am a healthcare professional under Act 40/1995 Coll. as amended by later regulations and that I have read the definition of a healthcare professional.