Repair of Mitral Valves with Severe Annular Dilatation and Abundant Leaflet Tissue Using a Prosthetic Ring with a Large Anterior-Posterior Diameter

Figures

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  Figure 1. The prosthetic rings available differ substantially in their ratios calculated between the cranial-caudal (A) and anterior-posterior diameter (B). The black arrow demonstrates the reduction of the A/B ratio in the different annuloplasty rings. As an example, a 38 mm size ring was evaluated, which is available from all manufacturers. Dimensions of the rings were provided by the manufacturers Medtronic, LivaNova, and Abbott. The dimensions of the Physio II ring are own measurements because of the restrictive policy of the manufacturer on providing the specifications of the product. LivaNova notes that because of the Nitinol cell core, the Memo3D ring shows a progressive degree of flexibility along the ring from the anterior to the posterior part.

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  Figure 2. Mitral valve morphology at baseline (ratio = C-C/A-P).

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  Figure 3. Study population at latest follow-up.

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  Figure 4. Survival.

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  Figure 5. Comparison of MR preoperatively, at hospital discharge, and at latest follow-up. The black arrows show the qualitative and quantitative (—n—) change in mitral regurgitation. We included only patients with complete echocardiographic follow-up. Patients who died in-hospital or during the follow-up period, patients who were lost to follow-up, and patients who were reoperated on have been excluded. MR, mitral regurgitation.

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  Figure 6. Cumulative incidence of reoperation.

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  Figure 7. Patients functional status preoperative and at discharge. (A): NYHA (New York Heart Association) class, (B): cardiac rhythm. SR: sinus rhythm, aFib: atrial fibrillation.