Cor Vasa 2020, 62(6):551-558 | DOI: 10.33678/cor.2020.054

Long-term outcomes of mitral valve repair with the Classic and Physio rings

Abubakari I. Sidiki^a, Alexandr G. Faybushevich^b, Alexandr N. Lishchuk^c, Alexandr N. Koltunov^c

^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

Background: The Carpentier-Edwards semi-rigid Physio ring (PR) is considered an improvement of the rigid Classic ring (CR). Hence, the former is nowadays widely used in mitral valve (MV) repair. We sought to compare the long-term outcomes of MV repair with the CR and PR in degenerative mitral valve disease (MVD).

Methods: In a computerized registry of our institution, 306 patients were found to have had MV repair with the CR (139 patients) or PR (167 patients) between 2005 and 2015. Fifteen of them had concomitant tricuspid valve repair. Out of the total number, 92 patients (30.1%) were diagnosed with Barlow's disease and 214 patients (69.9%) with fibroelastic deficiency. Patients in the two ring groups had similar demographic and echocardiographic characteristics.

Results: There were 4 (1.3%) operative mortalities. Mean follow-up time was 107.4 ± 13.2 months. Left ventricular end-diastolic and end-systolic diameters significantly improved in both groups, but were comparable between groups. Survival at ten years was 84.6% (93.1% in CR and 91.5% in PR; p = 0.177) and freedom from recurrent MR > 2+ was 74.5% (88.2% in CR and 86.3% in PR; p = 0.110) at 10 years. Reoperations for repair failure were eight in CR and six in PR. By Cox regression analysis, Barlow's disease, preoperative MR = 4+ and chordal shortening were predictors of repair failure. Old age (≥70 years), NYHA functional class IV and pulmonary artery systolic pressure (≥40 mmHg) were predictors of poor survival by univariate analysis.

Conclusions: Long-term outcomes of repair for degenerative MVD with the Classic and Physio rings are comparable. Artificial chordal implantation should be used instead of chordal shortening for degenerative chordae. Left ventricular outflow tract obstruction in Barlow's disease can be completely avoided by the use of large rings.

Keywords: Degenerative mitral valve disease, Mitral regurgitation, Mitral valve repair, Rigid ring, Semi-rigid ring

Received: April 4, 2020; Revised: April 4, 2020; Accepted: May 31, 2020; Published: December 11, 2020  Show citation