Midterm Results of Mitral Valve Repair: Closed Versus Open Annuloplasty Ring

Background. Closed and open annuloplasty rings are both used for mitral valve repair. This study compared the clinical and echocardiographic results in patients with degenerative mitral disease undergoing MV repair with closed semirigid rings vs open bands. Methods. Between 2004 and 2008, 377 patients (mean age, 59 +/- 12 years) underwent mitral valve repair. Valve pathology was degenerative in 273 (72%). Closed rings were used in 163 (60%) and open rings in 110 (40%). Patients had similar characteristics and comorbidities. In addition to annuloplasty, repair techniques included leaflet resection (48% and 77%, p < 0.01), artificial chordal (55% and 36%, p < 0.01), and edge-to-edge repair (4% and 4%, p = 0.79), in closed and open groups, respectively. Results. One patient in each group died (0.7%). Mean follow-up was 19 +/- 14 (closed group) and 34 +/- 15 months (open group; p < 0.01). Freedom from reoperation was 97.5% (closed group) vs 96.5% (open group). At follow-up, New York Heart Association functional class was similar between groups, and 91% in the closed group and 84% in the open group were free from moderate or severe mitral regurgitation (p = 0.05). Closed group patients had a longer line of leaflet coaptation (9.1 +/- 2.7 mm) vs the open group (7.1 +/- 1.9 mm; p < 0.01). Conclusions. Patients with closed semirigid annuloplasty rings demonstrated significantly longer lines of leaflet coaptation and tendency toward better echocardiographic midterm results than patients with open bands and may, therefore, benefit from improved repair durability. (Ann Thorac Surg 2010;90:489-96) (C) 2010 by The Society of Thoracic Surgeons