Annular stabilization in mitral repair without a prosthetic ring

Background and aim of the study: Annular stability is not guaranteed after mitral repair without a prost- hetic ring. We introduce a newly developed p lication technique and detail its stabilizing effect on the mitral annulus after Gerbode plasty. Methods: Patients suffered degenerative mitral valve prolapse with chordal rupture restricted to the middle scallop of the posterior leaflet. Between 1986 and 1997, 102 patients underwent Gerbode plasty with or without annula r reinforcement with a pericardial strip or modified Paneth plasty (group C ). The mean (+/- SD) follow up was 70.4 +/- 41.1 months. Since 1996, 32 pat ients have undergone a newly developed annuloplasty technique (group N), wh ere a pericardial strip was tightly anchored to the bilateral trigones and posterior annulus, which was folded by Gerbode plasty. With the final ancho ring suture the intention was to prevent plication breakdown of this portio n. Mean follow up for this group was 17.6 +/- 7.1 months. Progression of mi tral regurgitation after surgery in both groups was studied. Results: In group C, postoperative progression of mitral valve regurgitatio n occurred in 41.1% of patients (5.9% to grade 1, 17.6% to grade 2, 17.6% t o grade 3). Among these patients, reoperation was due to plication breakdow n of the Gerbode plasty in six cases (5.9%), and to either chordal rupture or annular dilatation in 10 cases each (9.8%). In contrast, no reoperation due to recurrent severe mitral regurgitation was needed in group N. Progres sion of mitral regurgitation after surgery was seen in six patients (two to grade 1; four to grade 2). Conclusion: The newly developed annuloplasty technique may be useful in sta bilizing the mitral annulus after Gerbode plasty.