title: Downsizing annuloplasty in ischemic mitral regurgitation: double row overlapping suture to avoid ring disinsertion in valve repair.
abstract: The long-term outcomes of undersizing annuloplasty for the treatment of ischemic mitral regurgitation (IMR) is affected by the progressive dilation of the annulus, which carries increased risk for ring disinsertion. Reasons underlying this phenomenon might be found in the excess of physical stress on the annuloplasty sutures during the ventricular remodeling process. We report a technique based on the placement of a double row of overlapping sutures aiming at reducing the potential for ring disinsertion. Eleven patients with IMR undergoing mitral valve repair associated with coronary bypass grafting were treated with this technique and echocardiographically followed up at 6 and 12 months. The overall annular dimension decreased significantly with a significant reduction of the tenting area and no recurrence of mitral regurgitation at 1 year. A double row of overlapping sutures allowed firm attachment of the prosthetic ring while downsizing the annulus in IMR, limiting the consequences of changes in subannular ventricular geometry. This technique might therefore be considered a useful aid during mitral valve repair.
authors.affiliation: Centre Cardiologique du Nord St. Denis, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nappi
authors.affiliation: Department of Cardiovascular Surgery University Campus Bio-Medico of Rome Rome, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spadaccio
authors.affiliation: Golden Jubilee National Hospital Clydebank, United Kingdom.
authors.forename: Nawwar
authors.initials: N
authors.lastname: Al-Attar
authors.affiliation: Department of Cardiovascular Surgery University Campus Bio-Medico of Rome Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Chello
authors.affiliation: Department of Cardiovascular Surgery University Campus Bio-Medico of Rome Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Lusini
authors.affiliation: Department of Cardiovascular Surgery University Campus Bio-Medico of Rome Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Barbato
authors.affiliation: Department of Cardiac Surgery Hopital La Pitie Salpetriere Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Acar