Long-term outcomes of semirigid ring and band annuloplasty in functional mitral regurgitation patients without advanced left ventricular dilation.

Abstract

Our study aims to compare the long-term survival and clinical outcomes of ring and band prostheses for annuloplasty repair of functional mitral regurgitation. From March 2005 to November 2017, 160 patients with moderate to severe functional mitral regurgitation underwent undersized annuloplasty using semirigid complete ring (N = 69) or partial band (N = 91) prostheses of the same material and manufacturer. Primary outcomes were long-term survival and clinical outcomes, and secondary outcomes included comparison of postoperative echocardiography data. Both groups had comparable baseline characteristics, cardiac function, functional mitral regurgitation severity, and perioperative complications. Complete ring and partial band groups experienced equivalent 10-year freedom from cardiovascular mortality (65.2% vs 68.3%, P = .39) and functional mitral regurgitation recurrence (78.5% vs 71.4%, P = .27). At a mean follow-up of 58 ± 46 months, both groups had a parallel increase in ejection fraction (+7% ± 16% vs +5% ± 15%, P = .35) and reduction of left ventricle internal diameter end-diastole (-0.5 ± 0.8 cm vs -0.4 ± 0.9 cm, P = .61). The complete ring group had greater reduction in left ventricle internal diameter end-systole (-0.6 ± 0.9 cm vs -0.2 ± 0.9 cm, P = .007) but higher mean (5.6 ± 3.4 mm Hg vs 5.0 ± 7 mm Hg, P = .025) and peak (16.7 ± 19.4 mm Hg vs 12.9 ± 10.7 mm Hg, P = .048) transvalvular pressure gradients. Mean transvalvular pressure gradient predicted postoperative mortality at 10 years (hazard ratio, 1.19; 95% CI, 1.0037-1.357; P = .013). Complete ring and partial band annuloplasty for functional mitral regurgitation confer equivalent 10-year survival and mitral regurgitation recurrence. Complete ring repair was associated with increased left ventricle reverse remodeling yet higher long-term valvular gradients.