Complete mitral valve ring repair reduces recurrent regurgitation

Sep 10 2012

By Liam Davenport, medwireNews Reporter

Mitral valve repair with complete versus partial ring annuloplasty results in lower levels of recurrence in patients with functional mitral regurgitation (FMR), conclude US investigators.

Frederick Chen, from Brigham and Women's Hospital, in Boston, Massachusetts, USA, and colleagues write: "The results of our study suggest that the higher rate of recurrent MR in the partial ring group is due, at least in part, to the overall effect that ongoing annular dilation of the anterior portion of the annulus has in altering the overall geometry of the mitral apparatus."

They add: "Several, but not all surgeons in our institution have shifted their practice from using partial rings to full rings for functional MR."

Reviewing the records of 548 patients diagnosed with FMR who underwent mitral real valve repair with ring annuloplasty between 1998 and 2008, the researchers found the percentage of patients receiving complete rings varied during the study period, but had increased to 81% by 2008.

Patients who received complete rings had significantly lower preoperative ejection fractions, at a median of 35% versus 40% for patients given partial rings, and were more likely to require preoperative intra-aortic balloon pump support compared with those receiving partial rings, at 11% versus 5%.

Complete rings were also associated with significantly longer perfusion times intra-operatively than partial rings, at a median of 180 versus 139 minutes, and longer cross-clamp times, at a median of 120 versus 97 minutes, the team notes in the Journal of Thoracic and Cardiovascular Surgery.

Recurrent MR was significantly more common in patients who received partial rings than those given complete rings, at 21% versus 10%. Median freedom from recurrent MR was significantly longer with complete versus partial rings by survival estimation, at 108 months versus 103 months, although there were no survival differences between the two groups, at a median of 103 months versus 101 months.

Risk-matched propensity analysis of 102 patients in each group, with an area under the curve of 0.824, suggested that patients given compete rings had lower risk for recurrent MR than those given partial rings on univariate analysis, at 7% versus 17%, while Kaplan-Meier analysis indicated a trend toward improved freedom from recurrent MR, at 110 months versus 104 months.

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