Mitral valve annuloplasty for degenerative disease: Assessment of four different techniques

Background and aim of the study: Mitral valve repair (MVR) is the treatment of choice in patients with degenerative valve disease. However, controvers y persists as to whether mitral valve annuloplasty should always be include d as part of the reconstructive procedure. Methods: The records of 62 consecutive patients undergoing MVR for degenera tive disease between January 1994 and December 1996 were reviewed. Four dif ferent annuloplasty techniques were associated with various MVR procedures: local posterior annuloplasty (group 1, n = 10), rigid Carpentier ring (gro up 2, n = 20), Duran ring (group 3, n = 17), and posterior annular plicatio n with autologous pericardium (group 4, n = 15). The four patient groups we re similar in terms of preoperative clinical and echocardiographic characte ristics. Serial clinical and echocardiographic follow up was performed to a ssess functional status and stability of repair. Results: There were no early or late deaths. Mean follow up in the entire p atient series was 31 +/- 12 months. One patient in group 2 required reopera tion 14 months after MVR. In all groups there was a significant improvement in NYHA functional class (from 2.7 +/- 0.6 to 0.9 +/- 0.5, p <0.001), with a reduction of left ventricular end-diastolic and end-systolic volumes (15 4 +/- 50 ml to 105 +/- 33 ml, p <0.001; and 64 +/- 23 ml to 52 +/- 22 ml, p <0.001). In patients of groups 2, 3 and 4, residual mitral incompetence at follow up (0.8 +/- 0.9 in group 2, 0.8 +/- 0.7 in group 3, and 0.2 +/- 0.6 in group 4) was not significantly different from discharge. However, in gr oup 1, a higher degree of residual mitral regurgitation was present at disc harge (0.9 +/- 0.6) with a trend to progress at follow up (1.6 +/- 0.5). Conclusion: In patients with degenerative mitral valve disease, MVR provide s clinical and functional improvement. Techniques of stabilization of the e ntire posterior mitral annulus achieve better early and medium-term results , and should be always considered as part of MVR. Autologous pericardium ap pears to be an excellent annuloplasty material, though its apparent superio rity over synthetic rings must be confirmed at longer follow up.