title: Interrupted commissural band annuloplasty for degenerative mitral valve disease.
abstract: BACKGROUND
  Mitral annuloplasty is useful for treating degenerative mitral valve disease. Although the incidence of complications is low, prosthetic ring-related complications can occur. Hemolysis and mitral stenosis are serious complications requiring reoperation. Limited use of prosthetic material could decrease the risk for complications. Commissural annuloplasty has been reported by Kay and Reed; their techniques involve suture plication. To prevent dehiscence, we selected short bands and compared the echocardiographic changes between this method and the Cosgrove ring.
  
  
  METHODS
  Three sutures are placed in the commissures using two bands, which shortens the annular length by 60%. We performed this interrupted commissural band annuloplasty (iCBA) in 63 patients and used Cosgrove bands for 58 patients.
  
  
  RESULTS
  Clinically, for iCBA and Cosgrove groups, respectively, hemolysis with mild mitral regurgitation occurred in 0 and 2 cases (p=0.084), and mitral stenosis due to pannus formation occurred in 0 and 1 case (p=0.224). There was a trend toward a lower ring-related complication rate in the iCBA group. On echocardiography, for the iCBA and Cosgrove groups, respectively, the maximum anterior-posterior distance of the annulus in diastole was 3.1±0.7 mm and 2.6±0.4 mm (p<0.001), maximum opening angle of the posterior leaflet was 85.7±17.3 degrees and 103.4±20.1 degrees (p<0.001), and coaptation distance was 11.6±3.7 mm and 8.4±2.6 mm (p<0.001).
  
  
  CONCLUSIONS
  The iCBA method prevented posterior leaflet tethering, kept the coaptation distance deep on echocardiography, and was associated with lower trends of ring-related complications. Because the posterior side of the annulus was not reconstructed, iCBA is suitable for fibroelastic deficiency, rather than for Barlow's disease.
authors.affiliation: Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, Komaki-City, Aichi, Japan. Electronic address: sawamasa7007bb@nifty.com.
authors.forename: Masaru
authors.initials: M
authors.lastname: Sawazaki
authors.affiliation: Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, Komaki-City, Aichi, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Tomari
authors.affiliation: Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, Komaki-City, Aichi, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Izawa
authors.affiliation: Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, Komaki-City, Aichi, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Zaikokuji
authors.affiliation: Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, Komaki-City, Aichi, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Tateishi
authors.affiliation: Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, Komaki-City, Aichi, Japan.
authors.forename: Yuusuke
authors.initials: Y
authors.lastname: Imaeda
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D014463:Ultrasonography
keywords: 35