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. 2019 Jun 13;14(1):108.
doi: 10.1186/s13019-019-0926-7.

Mitral valve repair: moving towards a personalized ring

Antonios Pitsis  1 , Timotheos Kelpis  2 , Efstratios Theofilogiannakos  2 , Nikolaos Tsotsolis  2 , Harisios Boudoulas  3 , Konstantinos Dean Boudoulas  3
Affiliations

Mitral valve repair: moving towards a personalized ring

Antonios Pitsis et al. J Cardiothorac Surg. .

Abstract

Background: Mitral valve repair with the use of an annuloplasty ring is the procedure of choice in patients with significant mitral regurgitation (MR) due to floppy mitral valve (FMV)/mitral valve prolapse (MVP). The mitral annular size, shape and motion may vary substantially among patients and thus, commercially available rings may not be suitable for each individual patient.

Methods: A "personalized ring" (PR) was easily constructed in the operating room using a Dacron sheet and titanium ligating clips to custom fit to each individual mitral annulus shape and size. There were 127 patients with severe MR due to FMV/MVP that underwent mitral valve repair surgery; 58 patients received a PR and 69 patients received a commercial Carpentier-Edwards Physio II ring. The patient records were retrospectively analysed.

Results: There were no surgical deaths. In-hospital length-of-stay and blood transfusions were not statistically different between the two groups. Mitral valve area was greater (p < 0.05) in the PR group (3.78 ± 0.22) compared to the Physio II ring group (3.13 ± 0.21). Mitral annular area changed from systole to diastole by 14.35% ± 3.28% in the PR group and did not change in the Physio II ring group (p < 0.05). Systolic anterior motion (SAM) of the mitral valve occurred in 2 patients with the Physio II ring and no patients with the PR. Up to 8 years follow-up, all patients in both groups were alive with NYHA functional class I-II symptoms and mild or less MR.

Conclusions: The PR is suitable for all patients with significant MR due to FMV/MVP who require MV repair. The precise fit of the PR to the mitral annulus better preserves valve area and sphincter function of the mitral annulus, prevents SAM and provides excellent short and long-term results.

Keywords: Floppy mitral valve; Mitral regurgitation; Mitral valve prolapse; Personalized ring; Repair.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
“Personalized ring” used for posterior mitral annuloplasty. The sutures are tied with the COR-KNOT device (CSI Solutions, USA)
Fig. 2
Fig. 2
Preparation and insertion of a “personalized ring” during mitral valve repair performed through median sternotomy
Fig. 3
Fig. 3
Commercial Physio II ring (upper panel) and the “personalized ring” (lower panel) are shown during diastole (left) and systole (right). Note that the mitral area in a patient with the “personalized ring” is dynamically changing from diastole to systole by 14%, while this area remains unchanged during the cardiac cycle in a patient with the commercial Physio II ring
See this image and copyright information in PMC

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