A second look at autopericardial mitral annuloplasty

Abstract

Objective: To compare total pericardial mitral annuloplasty (PeMA) and total prosthetic mitral annuloplasty (PrMA) in terms of durability in the treatment of degenerative, ischemic functional and non-ischemic functional mitral regurgitation (MR). Methods: We retrospectively reviewed prospectively collected data of 280 patients who received either PeMA (50.4%) or PrMA (with Carpentier-Edwards Physio rings; 49.6%) after valvuloplasty between 2008 and 2015. Combined procedures included: 40 CABG (PeMA 18, PrMA 22); 13 ablations with left atrial appendectomy (PrMA 8, PrMA 5); 7 tricuspid valve repairs (PeMA 2, PrMA 5); 9 closures of atrial septal defect (PeMA 3, PrMA 6). Results: Thirty-day mortality was 0.4%. Mean follow-up was 95.7% complete at 83.4 ± 13.0 months. The procedures were comparable in terms of 7 years: Freedom from reoperation and recurrent MR = 2+/3+ (PeMA 96.3%; PrMA 96.4%; p = 0.914); freedom from complications (PeMA 86.5%; PrMA 89.2%; p = 0.174); survival (PeMA 96.5%; PrMA 97.8%; p = 0.238). Overall 7-year survival was 97.1%. Old-age and concomitant CAD were significant predictors of reoperation and recurrent MR = 2+/3+ (p = 0.027; HR = 1.131 and p = 0.030; HR = 2.002 respectively) and independent predictive factors for poor survival (p = 0.029; HR = 4.251 and p = 0.040; HR = 1.135 respectively) by multivariate analysis. High preoperative LVEF was independently related to a lower risk of reoperation and recurrence of MR = 2+/3+ (p = 0.006; HR = 0.786) and better survival (p = 0.013; HR = 0.718) by multivariate analysis. Conclusions: With a reliable valvuloplasty, pericardial ring can be as durable as Physio ring and possibly surpass it with better methods of fixation. Cost-wise, pericardial ring is a better choice as it s free whilst Physio ring costs about $600. Prosthetic rings are not always associated with endocarditis, thromboembolism, valve calcification or hemolytic anemia.