The “Physio-Ring”: an advanced concept in mitral valve annuloplasty

A new annuloplasty ring has been developed with the aim of adding flexibility to the remodeling annuloplasty concept. Here we report its clinical use with special emphasis on segmental valve analysis and valve sizing. From October 1992 through June 1994, 137 patients aged 4 to 76 years (mean age, 49...

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Bibliographic Details
Published in:	The Annals of thoracic surgery Vol. 60; no. 5; pp. 1177 - 1186
Main Authors:	Carpentier, Alain F., Lessana, Arrigo, Relland, John Y.M., Belli, Emre, Mihaileanu, Serban, Berrebi, Alain J., Palsky, Evelyn, Loulmet, Didier F.
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Inc 01-11-1995
Subjects:	Adolescent Adult Aged Child Child, Preschool Female Follow-Up Studies Heart Valve Prosthesis - adverse effects Hospital Mortality Humans Male Middle Aged Mitral Valve Insufficiency - classification Mitral Valve Insufficiency - diagnostic imaging Mitral Valve Insufficiency - etiology Mitral Valve Insufficiency - surgery Monitoring, Intraoperative Prosthesis Design Recurrence Reoperation Severity of Illness Index Stroke Volume Ultrasonography
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Summary:	A new annuloplasty ring has been developed with the aim of adding flexibility to the remodeling annuloplasty concept. Here we report its clinical use with special emphasis on segmental valve analysis and valve sizing. From October 1992 through June 1994, 137 patients aged 4 to 76 years (mean age, 49.1 years) were operated on. The main causes of mitral valve insufficiency were degenerative, 90; bacterial endocarditis, 15; and rheumatic, 13. The indication for operation was based on the severity of the mitral valve insufficiency (90 patients were in grade III or IV) rather than on functional class (60 patients were in class III or IV). At echocardiography 6 patients had normal leaflet motion (type I), 119 leaflet prolapse (type II), and 12 restricted leaflet motion (type III). Surgical repair was carried out using Carpentier techniques of valve reconstruction. In 3 patients, inadequate ring sizing was responsible for systolic anterior motion of the anterior leaflet diagnosed by intraoperative echo. The valve was replaced in 2 patients. There were three hospital deaths, no late deaths, one reoperation for recurrent mitral valve insufficiency due to chordal rupture 1 month after repair, one reoperation for atrial thrombus formation 5 months after repair, one anticoagulant-related hemorrhage, and one thromboembolic episode. Mid-term follow-up between 6 and 18 months was available in 94 patients. Echocardiography showed trivial or no regurgitation in 93.2% of the patients and minimal regurgitation in 6.8%. The average transmitral diastolic gradient was 3.55 ± 1.93 mm Hg. Left ventricular end-systolic diameter and volume decreased postoperatively, demonstrating an improved left ventricular function. This preliminary experience has provided promising results and allowed us to define the indications of the Physio-Ring versus the classic ring. It has also shown that valve sizing and proper ring selection are of primary importance.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0003-4975 1552-6259
DOI:	10.1016/0003-4975(95)00753-8