scholarly journals Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

2021 ◽  
Author(s):  
Arian Arjomandi Rad ◽  
Vinci Naruka ◽  
Robert Vardanyan ◽  
Alessandro Viviano ◽  
Mohammad Yousuf Salmasi ◽  
...  
Keyword(s):  
Pooled Analysis ◽  
Ring Size ◽  
Inclusion Criteria ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Ring Annuloplasty ◽  
Cochrane Database ◽  
Significant Difference ◽  
Systematic Database

Abstract OBJECTIVES Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and predisposing risk factors for annuloplasty ring dehiscence include technical and pathological ones. METHODS A systematic database search with pooled analysis was conducted of original articles that only included dehiscence rate of mitral and tricuspid ring in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to November 2020. The outcomes included were dehiscence rate in mitral and tricuspid, type of ring implanted, dehiscence rate by pathology and by ring size and shape. RESULTS Our search yielded 821 relevant studies. Thirty-three studies met the inclusion criteria with a total of 10 340 patients (6543 mitral, 1414 tricuspid) of which 87 (mitral) and 30 (tricuspid) had dehiscence. Overall, dehiscence rate was 1.43%, diagnosed at a median of 4.5 ± 1.0 months postoperatively. A significant difference in mitral dehiscence rate was found by ring type (semi-rigid 1.86%, rigid 2.32%; flexible 0.43%; P < 0.001). There was no significant difference in rate of dehiscence by ring size (P = 0.067) and shape in mitral (P = 0.281) but there was higher dehiscence rate in ischaemic compared to non-ischaemic mitral regurgitation (3.91% vs 1.63%; P = 0.022). Among tricuspid studies, 9 of 10 studies did not report any dehiscence. CONCLUSIONS Although rigid, semi-rigid and flexible annuloplasty rings provide acceptable valve repair outcomes, mitral annuloplasty ring dehiscence is clinically more common among rigid rings. Understanding the multifactorial nature of ring dehiscence will help in identifying the patients at high risk and improve their clinical outcomes.

scholarly journals P1409 Sizing of mitral annuloplasty rings using three-dimensional transoesophageal echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Yoshitani ◽  
T Fujii ◽  
S Ito ◽  
A Shimokawa ◽  
Y Ohnishi
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Three Dimensional ◽  
Transoesophageal Echocardiography ◽  
Ring Size ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Systolic Phase

Abstract Funding Acknowledgements Department funding Background Mitral valve repair is preferred to valve replacement in cases of degenerative mitral regurgitation (MR) due to the lower risk of valve-related complications and operative mortality. In mitral valve repair, annuloplasty is associated with better clinical outcomes. Sizing of the annuloplasty ring with a ring sizer, which should be performed in the end-systolic phase, is performed in diastole during hyperkalaemia cardioplegic arrest. Three-dimensional transoesophageal echocardiography (3D-TEE) allows measurement of the mitral valve while the heart is beating, which is beneficial since the mitral valve size changes throughout the cardiac cycle. Purpose To investigate whether 3D-TEE measurements of the mitral valve are effective for preventing recurrent mitral regurgitation (MR) in patients who undergo mitral valve repair for degenerative MR. Methods This study retrospectively reviewed 139 patients who underwent mitral annuloplasty for degenerative MR. After 47 patients were excluded, 92 patients were analysed. The inter-commissural (IC) distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systolic phase. The annuloplasty ring size and type were selected by surgeons using specific ring sizers. We investigated the association of the IC distance with the size of implanted annulus ring and differences between the size of implanted annulus ring and the IC distance. We also compared the IC distance, the A2 height, and the ratio of A2 height to IC distance between patients with and without recurrent mild-to-moderate MR for 36 months. Results There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance (R²=0.7023, p < 0.001). The variety between implanted annulus ring size and IC distance measured by 3D-TEE was shown in Figure1. Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). The A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059). Conclusions There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance. Our results demonstrated a higher ratio of A2 height to IC distance in patients with recurrent MR. Abstract P1409 Figure1

scholarly journals Comparison of Ring and Suture Annuloplasty in the Treatment of Tricuspid Regurgitation

2021 ◽  
Author(s):  
Mateus Tamba ◽  
Quinling Fu ◽  
Kaili Han ◽  
Xiaoke Sun ◽  
Liang Zhang ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Optimal Method ◽  
Ring Group ◽  
Wilcoxon Rank Sum Test ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Suture Group

Background: Significant TR is common in patients with cardiac disease and because of its prognostic importance, TV came to the spotlight in the last decades. Functional TR is mostly treated when undergoing left-sided valve surgery, whereas idiopathic TR surgery is uncommon. The aim of this study is to compare the durability of tricuspid valve annuloplasty techniques, and to explore the optimal method for TV repair surgery. Methods: 1005 patients who underwent tricuspid valve repair from February 2012 to March 2019, were retrospectively studied. The patients had tricuspid valve repair while receiving surgery for other cardiac conditions. The study population was divided into Suture group (n=483, 48.1%), and Ring group (n=522, 51.9%). Data variation between and within the groups was analyzed with Mann-Whitney U test, Wilcoxon rank-sum test, and Radit analysis. Results: At two-year follow-up, in the Suture group, none/trace TR subjects were 63.9%, and 1.4% had severe TR; In the Ring group were: 63.9% none/trace, and 0.6% severe. Both groups’ two-year follow-up TR status was significantly different with preoperative TR status (p<0.05). At two-year follow-up, Suture group had 63.9% none/trace and 1.4% severe; and Ring group had 63.9% none/trace and 0.6% severe TR and there was no significant difference between the groups (p>0.05). Conclusions: Both annuloplasty techniques have good short-term outcomes. However, suture annuloplasty deteriorates faster than ring annuloplasty, making the latter to be the ideal technique for TV repair.

scholarly journals Annuloplasty ring dehiscence after mitral valve repair: incidence, localization and reoperation

2019 ◽  
Author(s):  
Thilo Noack ◽  
Philipp Kiefer ◽  
Nina Vivell ◽  
Franz Sieg ◽  
Mateo Marin-Cuartas ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mortality Rate ◽  
Survival Rates ◽  
Clinical Problem ◽  
Valve Repair ◽  
Term Survival ◽  
Annuloplasty Ring ◽  
Ring Annuloplasty ◽  
Short And Long Term

Abstract OBJECTIVES Mitral valve (MV) annuloplasty ring dehiscence with subsequent recurrent mitral regurgitation represents an unusual but challenging clinical problem. Incidence, localization and outcomes for this complication have not been well defined. METHODS From 1996 to 2016, a total of 3478 patients underwent isolated MV repair with ring annuloplasty at the Leipzig Heart Centre. Of these patients, 57 (1.6%) underwent reoperation due to annuloplasty ring dehiscence. Echocardiographic data, operative and early postoperative characteristics as well as short- and long-term survival rates after MV reoperation were analysed. RESULTS Occurrences of ring dehiscence were acute (<30 days), early (≤1 year) and late (>1 year) in 44%, 33% and 23% of patients, respectively. Localization of annuloplasty ring dehiscence was found most frequently in the P3 segment (68%), followed by the P2 (51%) and the P1 segments (47%). The 30-day mortality rate and 1- and 5-year survival rates after MV reoperation were 2%, 89% and 74%, respectively. During reoperation, MV replacement was performed in 38 (67%) and MV re-repair in 19 (33%) patients. CONCLUSIONS Annuloplasty ring dehiscence is clinically less common, localized more frequently on the posterior annulus and occurs mostly acutely or early after MV repair. MV reoperation can be performed safely in such patients.

scholarly journals Computer-based comparison of different methods for selecting mitral annuloplasty ring size

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Sameer Al-Maisary ◽  
Sandy Engelhardt ◽  
Bastian Graser ◽  
Ivo Wolf ◽  
Matthias Karck ◽  
...  
Keyword(s):  
Ring Size ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Computer Based

scholarly journals Mastering Mitral Leaflets Coaptation After Valve Repair with Adjustable Mitral Annuloplasty Ring

ASAIO Journal ◽  
2017 ◽  
Vol 63 (2) ◽  
pp. 168-173 ◽  
Author(s):  
Piergiorgio Tozzi ◽  
Daniel Hayoz ◽  
Carlo Antona ◽  
Gianfranco B. Fiore ◽  
Giuseppe Siniscalchi ◽  
...  
Keyword(s):  
Valve Repair ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty

scholarly journals Early Period Mitral Stenosis After Mitral Annuloplasty: Functional or Real Stenosis?

2021 ◽  
Author(s):  
Serkan Asil ◽  
Veysel Özgür Barış ◽  
Suat Görmel ◽  
Murat Çelik ◽  
Uygar Çağdaş Yüksel
Keyword(s):  
Case Report ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Mitral Stenosis ◽  
Early Period ◽  
Valve Repair ◽  
Mitral Valve Leaflet ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty

Abstract Background:Surgical repair of rheumatic mitral valve disease is technically more demanding however, mitral repair is preferred over mechanical valve implantation if possible. İn this case report we presented the case of functional mitral stenosis after surgical mitral valve repair and annuloplasty ring implantation for rheumatic mitral regurgitation. Case Report:A 64-year-old female patient was admitted to our clinic with progressively worsening shortness of breath (New York Heart Association-Classification II-III), 6 months after surgical mitral valve repair and annuloplasty ring implantation for rheumatic mitral regurgitation. The 28/13 mmHg gradient was observed in the mitral valve annuloplasty ring in transthoracic echocardiography. TEE findings showed that motions of the mitral valve leaflet were fine, but in the mitral annuloplasty ring there was an extreme constriction and increased gradient.Conclusion:The development of mitral stenosis following mitral valve surgery is a condition associated with multiple mechanisms that are poorly understood. Mitral valve repair can be difficult and low success rate, especially in rheumatic mitral valve patients. The defect in the surgical technique and the application of restrictive small annuloplasty causes an increased gradient, leading to the development of severe functional mitral stenosis, especially when accompanied by a slight increase in pannus tissue.

scholarly journals Patient–prosthesis mismatch in mitral annuloplasty for degenerative mitral regurgitation: an ignored issue

2019 ◽  
Vol 56 (5) ◽  
pp. 976-982 ◽  
Author(s):  
Wenrui Ma ◽  
Wei Shi ◽  
Weihua Wu ◽  
Xinyu Ma ◽  
Ye Kong ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Propensity Score ◽  
Mitral Valve Repair ◽  
Exponential Model ◽  
Ring Size ◽  
Valve Repair ◽  
Mitral Annuloplasty ◽  
Regression Curves ◽  
Patient Prosthesis Mismatch

Abstract OBJECTIVES Elevated postoperative transmitral gradient (TMG), partially induced by a small annuloplasty ring, is associated with late atrial fibrillation (AF) after mitral valve repair. Here, we aimed to provide the optimal cut-off of prosthetic ring size to reduce patient–prosthesis mismatch (PPM) after mitral annuloplasty. METHODS From 2006 to 2017, 262 patients who underwent mitral valve repair for degenerative pathologies were retrospectively studied. The relationships of body surface area (BSA)–indexed prosthetic orifice area (POAi)–postoperative TMG and POAi–late AF were tested using regression curves and receiver operating characteristic curves, respectively. The optimal cut-off of POAi predictive of late AF was used to define PPM. Baseline and follow-up data of patients with and without PPM were compared in propensity score-matched cohorts. RESULTS In-hospital mortality was 0. Late AF was observed in 9.2% (24/262) patients during a median follow-up of 3.8 years. An exponential model was best fitted based on the POAi–postoperative TMG relationship (P < 0.001). Using late AF as the dependent variable, the optimal cut-off for PPM was POAi ≤2.28 cm2/m2 (c-statistic 0.71; sensitivity 0.61; specificity 0.80; P < 0.001). PPM was identified in 113 (43.1%) patients. After propensity score matching, the estimated 5-year rate of late AF was significantly higher in PPM patients than in non-PPM patients (24% vs 5%; P < 0.001). CONCLUSIONS Postoperative TMG increases significantly with a small POAi for full ring annuloplasty. A patient’s BSA should be considered in addition to valvular dimensions during the selection of a proper ring size to reduce PPM-related AF.

Use of Pledgeted Sutures in Mitral Annuloplasty

2014 ◽  
Vol 9 (2) ◽  
pp. 148-149
Author(s):  
Mohammed Hassan ◽  
Jimmy Windsor ◽  
Tomas Salerno ◽  
Marco Ricci
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Suture Placement

Annuloplasty ring or band dehiscence is a possible complication of mitral valve repair surgery. It may be due to increased tension on the annuloplasty sutures, especially in ischemic mitral pathology in which a circumferential ring is used. Herein, we describe a technique for alternative suture placement in mitral annuloplasty using pledgeted sutures that may reduce the risk for ring or band dehiscence.

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