title: Initial clinical experience with Myxo-ETlogix mitral valve repair ring.
abstract: OBJECTIVE
  Complexity of mitral valve repair for myxomatous disease has led to low adoption. We report initial experience with a new ring designed specifically for myxomatous disease, the Myxo-ETlogix (Edwards Lifesciences LLC, Irvine, Calif).
  
  
  METHODS
  From March 15, 2006, through November 19, 2007, 129 patients underwent mitral valve surgery for pure myxomatous disease, and 124 valves (96.1%) were repaired. The Myxo-ETlogix ring was used in 100 cases and the Physio ring (Edwards) in 24. The Myxo-ETlogix design includes a 3-dimensional shape to reduce systolic anterior motion and a larger orifice to accommodate elongated leaflets and decrease need for sliding plasty. Direct mitral valve measurements were made. Sizing was based on A2 height, and choice of ring type was based on unresected leaflet heights.
  
  
  RESULTS
  There was no operative mortality or lasting perioperative morbidity. The Myxo-ETlogix group had taller A2, P1, P2, and P3 leaflet segments than the Physio group (P < or = .003). Only 1 sliding plasty was performed for asymmetry in the Myxo-ETlogix group. Predischarge and follow-up echocardiograms (n = 338 in 124 patients) disclosed transient nonobstructive chordal systolic anterior motion in 3 echocardiograms in 3 patients. No patients had 2+ or greater mitral regurgitation. At discharge, 5.7% had 1+ mitral regurgitation; this proportion was 17.3% at last follow-up (mean 6.1 +/- 4.4 months).
  
  
  CONCLUSIONS
  In initial experience with the Myxo-ETlogix ring, nonobstructive systolic anterior motion has been rare and obstructive systolic anterior motion not observed. Ongoing prospective echocardiographic and clinical studies will elucidate the role of this etiology-specific ring.
authors.affiliation: Bluhm Cardiovascular Institute, Division of Cardiothoracic Surgery, Northwestern Memorial Hospital, Chicago, Ill 60611, USA. pmccart@nmh.org
authors.forename: P M
authors.initials: PM
authors.lastname: McCarthy
authors.forename: E C
authors.initials: EC
authors.lastname: McGee
authors.forename: V H
authors.initials: VH
authors.lastname: Rigolin
authors.forename: Q
authors.initials: Q
authors.lastname: Zhao
authors.forename: H
authors.initials: H
authors.lastname: Subacius
authors.forename: A L
authors.initials: AL
authors.lastname: Huskin
authors.forename: S
authors.initials: S
authors.lastname: Underwood
authors.forename: B J
authors.initials: BJ
authors.lastname: Kane
authors.forename: I
authors.initials: I
authors.lastname: Mikati
authors.forename: G
authors.initials: G
authors.lastname: Gang
authors.forename: R O
authors.initials: RO
authors.lastname: Bonow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000628:therapy*; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D016896:Treatment Outcome