INITIAL EXPERIENCE WITH THE COSGROVE-EDWARDS ANNULOPLASTY SYSTEM

Background. The mitral valve has a nonplanar shape and a sphincter act ion. Pathologic dilatation occurs along the posterior annulus. To pres erve the physiologic function and correct annular dilatation, we devel oped an annuloplasty system that is universally flexible and produces a measured plication of the posterior annulus (Cosgrove-Edwards Annulo plasty System). Methods. The results of 150 consecutive mitral valve r epairs using this system were analyzed. Mean age was 58 +/- 13 years; 59% were men. The cause of the valve disease was degenerative in 75% o f the patients, rheumatic in 13%, ischemic in 8%, and infectious in 4% . Associated procedures were performed in 61 patients (41%). Results. Echocardiographic mitral regurgitation decreased from 3.7 +/- 0.6 befo re repair to 0.2 +/- 0.4 after repair (p < 0.0001). There were no hosp ital deaths and no cases of hemodynamically significant systolic anter ior motion or other annuloplasty-related complications. Follow-up was 100% complete at a mean of 3.1 +/- 3.6 months. There were three late d eaths, three transient ischemic attacks, and one episode of endocardit is. Five patients (3.3%) have undergone reoperation for recurrent mitr al insufficiency; no reoperations were related to the annuloplasty sys tem. At a mean of 9 months, three-dimensional reconstruction of the mi tral annulus from multiple echocardiographic images confirmed the nonp lanar shape and sphincter mechanism of the annulus. Annular orifice ar ea decreased 19% during the cardiac cycle from a mean of 10.3 cm(2) in diastole to 8.6 cm(2) in systole. Conclusions. This annuloplasty syst em is effective for repair of insufficiency secondary to all causes, p reserves physiologic annulus function, and is associated with a low in cidence of valve-related complication.