Key result
A double row of overlapping sutures for downsizing annuloplasty significantly reduced the mean mitral regurgitation grade compared to a conventional single row at 12 months (0.7 vs 1.6; P=0.0003).
Why the study?
Does a double row of overlapping sutures for downsizing annuloplasty reduce residual mitral regurgitation in patients with ischaemic mitral regurgitation?
RCT (n=36)
Does a double row of overlapping sutures for downsizing annuloplasty reduce residual mitral regurgitation in patients with ischaemic mitral regurgitation?
Absolute Event Rate: 0.7% vs 1.6%
p-value: p=0.0003
Using a double row of overlapping sutures for downsizing annuloplasty in ischemic mitral repair significantly reduces the risk of residual mitral regurgitation and improves annulus narrowing compared to the conventional single row technique.
Supports double-row overlapping sutures in ischemic MR repair; extends annuloplasty technique comparisons in RCTs.
OBJECTIVES: The aim of this study was to evaluate a novel insertion technique of the prosthetic ring that would further magnify the degree of annulus narrowing, thereby reducing the potential for a residual leak in ischaemic mitral valve repair. METHODS: Thirty-six patients with ischaemic mitral regurgitation (MR) were randomly assigned into two groups. In 18 patients, the prosthetic ring was inserted in the conventional manner with a single row of sutures (control group). In the remaining 18 patients, the ring was attached using a double row of sutures tied both on the inner and on the outer part of the sewing cuff. Both groups had similar preoperative clinical and echocardiographic characteristics with severe leaflet tethering: mean tenting area >2.5 cm(2), mean anterior leaflet angle >25° and posterior leaflet angle >45°. The mean prosthetic ring sizes inserted in both groups were identical (mean: 27.3 mm). RESULTS: At 12 months, there was no clinical event except for 1 rehospitalization in the control group. The mean mitral regurgitation grade was higher in the control group than in the group with the double row of sutures at 1.6 ± 0.9 vs 0.7 ± 0.3 (P = 0.0003). Annulus diameter reduction was less pronounced in the control group when compared with the group with the double row of sutures, both in the parasternal long-axis: 29.3 ± 3 vs 26.3 ± 3 mm (P = 0.0003) and in apical four-chamber views: 31 ± 3 vs 28 ± 2 mm (P = 0.003). Leaflet tethering indices were greater in the control group than in the group with the double row of sutures: tenting area: 1.42 ± 0.3 vs 1.1 ± 0.5 cm(2) (P = 0.002), anterior leaflet angle: 33 ± 3° vs 28 ± 5° (P = 0.0009) and posterior leaflet angle: 110 ± 13° vs 80 ± 11° (P = 0.0001). Left ventricular function parameters were not statistically different among the two groups. CONCLUSION: A double row of overlapping sutures for attaching the prosthetic ring in downsizing annuloplasty is more efficient in narrowing the mitral annulus than the conventional technique in ischaemic mitral repair. Even in high-risk patients whose leaflets were severely tethered on echocardiography, it almost eliminated the risk of MR recurrence in this study.
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Nappi et al. (2015) conducted an RCT in Ischaemic mitral regurgitation (n=36). Double row of overlapping sutures for downsizing annuloplasty vs. Conventional single row of sutures was evaluated on Mean mitral regurgitation grade at 12 months (p=0.0003). A double row of overlapping sutures for downsizing annuloplasty significantly reduced the mean mitral regurgitation grade compared to a conventional single row at 12 months (0.7 vs 1.6; P=0.0003).
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