Long-term outcomes of semirigid ring and band annuloplasty in functional mitral regurgitation patients without advanced left ventricular dilation

Abstract

Objective: Our study aims to compare the long-term survival and clinical outcomes of ring and band prostheses for annuloplasty repair of functional mitral regurgitation.

Methods: From March 2005 to November 2017, 160 patients with moderate to severe functional mitral regurgitation underwent undersized annuloplasty using semirigid complete ring (N = 69) or partial band (N = 91) prostheses of the same material and manufacturer. Primary outcomes were long-term survival and clinical outcomes, and secondary outcomes included comparison of postoperative echocardiography data.

Results: Both groups had comparable baseline characteristics, cardiac function, functional mitral regurgitation severity, and perioperative complications. Complete ring and partial band groups experienced equivalent 10-year freedom from cardiovascular mortality (65.2% vs 68.3%, P = .39) and functional mitral regurgitation recurrence (78.5% vs 71.4%, P = .27). At a mean follow-up of 58 ± 46 months, both groups had a parallel increase in ejection fraction (+7% ± 16% vs +5% ± 15%, P = .35) and reduction of left ventricle internal diameter end-diastole (-0.5 ± 0.8 cm vs -0.4 ± 0.9 cm, P = .61). The complete ring group had greater reduction in left ventricle internal diameter end-systole (-0.6 ± 0.9 cm vs -0.2 ± 0.9 cm, P = .007) but higher mean (5.6 ± 3.4 mm Hg vs 5.0 ± 7 mm Hg, P = .025) and peak (16.7 ± 19.4 mm Hg vs 12.9 ± 10.7 mm Hg, P = .048) transvalvular pressure gradients. Mean transvalvular pressure gradient predicted postoperative mortality at 10 years (hazard ratio, 1.19; 95% CI, 1.0037-1.357; P = .013).

Conclusions: Complete ring and partial band annuloplasty for functional mitral regurgitation confer equivalent 10-year survival and mitral regurgitation recurrence. Complete ring repair was associated with increased left ventricle reverse remodeling yet higher long-term valvular gradients.

Keywords: annuloplasty; functional mitral regurgitation; mitral valve; mitral valve repair.