title: Flexible versus nonflexible mitral valve rings for congestive heart failure: differential durability of repair.
abstract: BACKGROUND
  Surgical intervention is playing an increasingly important therapeutic role in congestive heart failure (CHF) patients with ischemia and dilated cardiomyopathy. Their mitral regurgitation (MR) is a result of left ventricular (LV) geometrical distortion. The optimal type of ring for CHF patients with geometric ventricular-based MR is unknown. This study reviewed the results of flexible versus nonflexible complete mitral valve rings in CHF patients with geometric mitral regurgitation.
  
  
  RESULTS
  Using a prospectively maintained database, patients undergoing mitral valve reconstruction (MVR) with either a flexible or nonflexible complete ring were identified on the basis of preoperative ejection fraction (EF) < or = 30% and no primary mitral pathology. These 2 groups of CHF patients with severe geometric MR were then compared in terms of recurrent MR requiring reoperation. Between 1992 and 2004, 289 patients with EF < or = 30%, received an undersized complete mitral annuloplasty ring as their MVR procedure. Of these, 170 patients had a flexible complete ring. In follow-up, 16 "flexible" patients (9.4%) required a repeat procedure for significant recurrent geometric MR and CHF (10 replacements, 3 re-repairs, 3 transplants). The average time to reoperation was 2.4 years. In contrast, 119 patients with an EF < or = 30% received a MVR using an undersized nonflexible complete ring. Only 3 "non-flexible" patients required a repeat operation, MVR (1), and 2 patients required a transplant. The time to reoperation was 4.0 years. A significant difference in reoperation rates, for recurrent MR, between the 2 groups (P=0.012). There were no differences between groups, in terms of age, ring size used, preoperative EF, LV size, MR grade, or New York Heart Association class.
  
  
  CONCLUSIONS
  Patients with CHF having a flexible ring have a higher likelihood of developing recurrent MR requiring reoperation. The use of a nonflexible ring appears to significantly reduce the need for repeat surgical procedures. Further refinement and development of nonflexible ring systems, aimed at LV restoration, deserve ongoing investigation.
authors.affiliation: Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan 48109-0348, USA.
authors.forename: Martinus T
authors.initials: MT
authors.lastname: Spoor
authors.forename: Amy
authors.initials: A
authors.lastname: Geltz
authors.forename: Steven F
authors.initials: SF
authors.lastname: Bolling
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000473:pathology; D003131:Combined Modality Therapy; D016208:Databases, Factual; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006352:Heart Ventricles / Q000473:pathology*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D009638:Norepinephrine / Q000627:therapeutic use; D018583:Pliability; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D013148:Spironolactone / Q000627:therapeutic use; D013318:Stroke Volume; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000601:surgery; D014463:Ultrasonography
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D013148:Spironolactone; D004077:Digoxin; D020105:Milrinone; D001241:Aspirin; D009638:Norepinephrine