Mitral valve repair using a semirigid ring: patient selection and early outcomes

Background Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for...

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Veröffentlicht in:Asian cardiovascular & thoracic annals 2016-09, Vol.24 (7), p.647-652
Hauptverfasser: Wan, Song, Lee, Alex PW, Attaran, Saina, Yu, Peter SY, Au, Sylvia SW, Kwok, Micky WT, Lau, Rainbow WH, Wong, Randolph HL, Wan, Innes YP, Ng, Siu-Keung, Underwood, Malcolm J
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container_end_page 652
container_issue 7
container_start_page 647
container_title Asian cardiovascular & thoracic annals
container_volume 24
creator Wan, Song
Lee, Alex PW
Attaran, Saina
Yu, Peter SY
Au, Sylvia SW
Kwok, Micky WT
Lau, Rainbow WH
Wong, Randolph HL
Wan, Innes YP
Ng, Siu-Keung
Underwood, Malcolm J
description Background Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair. Methods We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative (n = 60) or functional (n = 6) mitral regurgitation had Memo 3D (n = 32) or Memo 3D ReChord (n = 34) rings implanted. Results Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up. Conclusions Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.
doi_str_mv 10.1177/0218492316659970
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A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair. Methods We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative (n = 60) or functional (n = 6) mitral regurgitation had Memo 3D (n = 32) or Memo 3D ReChord (n = 34) rings implanted. Results Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up. Conclusions Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.</description><identifier>ISSN: 0218-4923</identifier><identifier>EISSN: 1816-5370</identifier><identifier>DOI: 10.1177/0218492316659970</identifier><identifier>PMID: 27448551</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Aged ; Echocardiography, Transesophageal ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation - adverse effects ; Heart Valve Prosthesis Implantation - instrumentation ; Humans ; Male ; Middle Aged ; Mitral Valve - diagnostic imaging ; Mitral Valve - physiopathology ; Mitral Valve - surgery ; Mitral Valve Annuloplasty - adverse effects ; Mitral Valve Annuloplasty - instrumentation ; Mitral Valve Insufficiency - diagnostic imaging ; Mitral Valve Insufficiency - physiopathology ; Mitral Valve Insufficiency - surgery ; Patient Selection ; Polytetrafluoroethylene ; Prosthesis Design ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome</subject><ispartof>Asian cardiovascular &amp; thoracic annals, 2016-09, Vol.24 (7), p.647-652</ispartof><rights>The Author(s) 2016</rights><rights>The Author(s) 2016.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c252t-f31e2c052af263ea304e139a35bdc57fa36699524b0faeadc1fa2750b124203d3</citedby><cites>FETCH-LOGICAL-c252t-f31e2c052af263ea304e139a35bdc57fa36699524b0faeadc1fa2750b124203d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0218492316659970$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0218492316659970$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27448551$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wan, Song</creatorcontrib><creatorcontrib>Lee, Alex PW</creatorcontrib><creatorcontrib>Attaran, Saina</creatorcontrib><creatorcontrib>Yu, Peter SY</creatorcontrib><creatorcontrib>Au, Sylvia SW</creatorcontrib><creatorcontrib>Kwok, Micky WT</creatorcontrib><creatorcontrib>Lau, Rainbow WH</creatorcontrib><creatorcontrib>Wong, Randolph HL</creatorcontrib><creatorcontrib>Wan, Innes YP</creatorcontrib><creatorcontrib>Ng, Siu-Keung</creatorcontrib><creatorcontrib>Underwood, Malcolm J</creatorcontrib><title>Mitral valve repair using a semirigid ring: patient selection and early outcomes</title><title>Asian cardiovascular &amp; thoracic annals</title><addtitle>Asian Cardiovasc Thorac Ann</addtitle><description>Background Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair. Methods We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative (n = 60) or functional (n = 6) mitral regurgitation had Memo 3D (n = 32) or Memo 3D ReChord (n = 34) rings implanted. Results Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up. Conclusions Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.</description><subject>Aged</subject><subject>Echocardiography, Transesophageal</subject><subject>Female</subject><subject>Heart Valve Prosthesis</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Heart Valve Prosthesis Implantation - instrumentation</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mitral Valve - diagnostic imaging</subject><subject>Mitral Valve - physiopathology</subject><subject>Mitral Valve - surgery</subject><subject>Mitral Valve Annuloplasty - adverse effects</subject><subject>Mitral Valve Annuloplasty - instrumentation</subject><subject>Mitral Valve Insufficiency - diagnostic imaging</subject><subject>Mitral Valve Insufficiency - physiopathology</subject><subject>Mitral Valve Insufficiency - surgery</subject><subject>Patient Selection</subject><subject>Polytetrafluoroethylene</subject><subject>Prosthesis Design</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0218-4923</issn><issn>1816-5370</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEtLw0AUhQdRbK3uXcks3UTnkclk3EnxBRVd6DrcTG7KlLycSQr99ya0uhBcXTjnOwfuIeSSsxvOtb5lgqexEZIniTJGsyMy5ylPIiU1OybzyY4mf0bOQtgwxiSX6SmZCR3HqVJ8Tt5fXe-holuotkg9duA8HYJr1hRowNp5t3YF9aNwRzvoHTb9qFdoe9c2FJqCIvhqR9uht22N4ZyclFAFvDjcBfl8fPhYPkert6eX5f0qskKJPiolR2GZElCKRCJIFiOXBqTKC6t0CTJJjFEizlkJCIXlJQitWM5FLJgs5IJc73s7334NGPqsdsFiVUGD7RCycQcujDJCjyjbo9a3IXgss867Gvwu4yybdsz-7jhGrg7tQ15j8Rv4GW4Eoj0QYI3Zph18M377f-E3GXF6Lg</recordid><startdate>201609</startdate><enddate>201609</enddate><creator>Wan, Song</creator><creator>Lee, Alex PW</creator><creator>Attaran, Saina</creator><creator>Yu, Peter SY</creator><creator>Au, Sylvia SW</creator><creator>Kwok, Micky WT</creator><creator>Lau, Rainbow WH</creator><creator>Wong, Randolph HL</creator><creator>Wan, Innes YP</creator><creator>Ng, Siu-Keung</creator><creator>Underwood, Malcolm J</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201609</creationdate><title>Mitral valve repair using a semirigid ring: patient selection and early outcomes</title><author>Wan, Song ; Lee, Alex PW ; Attaran, Saina ; Yu, Peter SY ; Au, Sylvia SW ; Kwok, Micky WT ; Lau, Rainbow WH ; Wong, Randolph HL ; Wan, Innes YP ; Ng, Siu-Keung ; Underwood, Malcolm J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c252t-f31e2c052af263ea304e139a35bdc57fa36699524b0faeadc1fa2750b124203d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Echocardiography, Transesophageal</topic><topic>Female</topic><topic>Heart Valve Prosthesis</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Heart Valve Prosthesis Implantation - instrumentation</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mitral Valve - diagnostic imaging</topic><topic>Mitral Valve - physiopathology</topic><topic>Mitral Valve - surgery</topic><topic>Mitral Valve Annuloplasty - adverse effects</topic><topic>Mitral Valve Annuloplasty - instrumentation</topic><topic>Mitral Valve Insufficiency - diagnostic imaging</topic><topic>Mitral Valve Insufficiency - physiopathology</topic><topic>Mitral Valve Insufficiency - surgery</topic><topic>Patient Selection</topic><topic>Polytetrafluoroethylene</topic><topic>Prosthesis Design</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>online_resources</toplevel><creatorcontrib>Wan, Song</creatorcontrib><creatorcontrib>Lee, Alex PW</creatorcontrib><creatorcontrib>Attaran, Saina</creatorcontrib><creatorcontrib>Yu, Peter SY</creatorcontrib><creatorcontrib>Au, Sylvia SW</creatorcontrib><creatorcontrib>Kwok, Micky WT</creatorcontrib><creatorcontrib>Lau, Rainbow WH</creatorcontrib><creatorcontrib>Wong, Randolph HL</creatorcontrib><creatorcontrib>Wan, Innes YP</creatorcontrib><creatorcontrib>Ng, Siu-Keung</creatorcontrib><creatorcontrib>Underwood, Malcolm J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Asian cardiovascular &amp; thoracic annals</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wan, Song</au><au>Lee, Alex PW</au><au>Attaran, Saina</au><au>Yu, Peter SY</au><au>Au, Sylvia SW</au><au>Kwok, Micky WT</au><au>Lau, Rainbow WH</au><au>Wong, Randolph HL</au><au>Wan, Innes YP</au><au>Ng, Siu-Keung</au><au>Underwood, Malcolm J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mitral valve repair using a semirigid ring: patient selection and early outcomes</atitle><jtitle>Asian cardiovascular &amp; thoracic annals</jtitle><addtitle>Asian Cardiovasc Thorac Ann</addtitle><date>2016-09</date><risdate>2016</risdate><volume>24</volume><issue>7</issue><spage>647</spage><epage>652</epage><pages>647-652</pages><issn>0218-4923</issn><eissn>1816-5370</eissn><abstract>Background Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair. Methods We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative (n = 60) or functional (n = 6) mitral regurgitation had Memo 3D (n = 32) or Memo 3D ReChord (n = 34) rings implanted. Results Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up. Conclusions Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>27448551</pmid><doi>10.1177/0218492316659970</doi><tpages>6</tpages></addata></record>
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subjects Aged
Echocardiography, Transesophageal
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects
Heart Valve Prosthesis Implantation - instrumentation
Humans
Male
Middle Aged
Mitral Valve - diagnostic imaging
Mitral Valve - physiopathology
Mitral Valve - surgery
Mitral Valve Annuloplasty - adverse effects
Mitral Valve Annuloplasty - instrumentation
Mitral Valve Insufficiency - diagnostic imaging
Mitral Valve Insufficiency - physiopathology
Mitral Valve Insufficiency - surgery
Patient Selection
Polytetrafluoroethylene
Prosthesis Design
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
title Mitral valve repair using a semirigid ring: patient selection and early outcomes
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