COMPARATIVE EFFICACY OF RING AND SUTURE ANNULOPLASTY FOR ISCHEMIC MITRAL REGURGITATION

Background. Patients with ischemic mitral regurgitation (MR) represent a therapeutic challenge, and results after combined valve replacement and revascularization have been poor. Valve repair is a promising approach, but the optimal method of repair is not known. Methods and Results. In 60 patients with coronary artery disease and 3+ or 4+ MR, we used intraoperative Doppler echocardiography to study the efficacy of Carpentier-Edwards ring (n = 27) and commissural suture (n = 33) annuloplasty. Patients with ruptured papillary muscles, torn chordae, and ballooning or scalloping of the leaflets were excluded. Ring and suture groups were similar in preoperative ejection fraction (35+/-14% and 34+/-17%), MR grade (3.5+/-0.5 and 3.4+/-0.6), and acuity of MR (41% and 33% acute) (p = NS). Postoperatively, the ring group achieved a lower residual MR grade than the suture group (0.5+/-0.5 versus 1.5+/-1.1; p < 0.001), and the mitral annular diameter was reduced to a greater extent in the ring group (by 1.5+/-0.5 cm versus 0.5+/-0.4 cm; p < 0.001). Success (greater-than-or-equal-to 2 grade MR reduction) was more frequent in the ring than in the suture group (96% versus 67%, p < 0.01). One-year survival was similar (74+/-9% ring, 71+/-8% suture). Follow-up Doppler studies showed a higher mean gradient (4.0+/-1.2 mm Hg) and smaller valve area (2.1+/-0.5 cm2) in the ring group, but the postoperative New York Heart Association class was similar in both groups (83% versus 74% class I-II). Conclusions. Ring annuloplasty provides a more effective reduction of ischemic MR and a higher success rate than the suture technique. This may be related to uniform rather than localized shortening of the annulus and a greater reduction in annulus diameter.