Double row of overlapping sutures for downsizing annuloplasty decreases the risk of residual regurgitation in ischaemic mitral valve repair.
OBJECTIVE
The aim of this study was to evaluate a novel insertion technique of the prosthetic ring that would further magnify the degree of annulus narrowing, thereby reducing the potential for a residual leak in ischaemic mitral valve repair.


METHODS
Thirty-six patients with ischaemic mitral regurgitation (MR) were randomly assigned into two groups. In 18 patients, the prosthetic ring was inserted in the conventional manner with a single row of sutures (control group). In the remaining 18 patients, the ring was attached using a double row of sutures tied both on the inner and on the outer part of the sewing cuff. Both groups had similar preoperative clinical and echocardiographic characteristics with severe leaflet tethering: mean tenting area >2.5 cm(2), mean anterior leaflet angle >25° and posterior leaflet angle >45°. The mean prosthetic ring sizes inserted in both groups were identical (mean: 27.3 mm).


RESULTS
At 12 months, there was no clinical event except for 1 rehospitalization in the control group. The mean mitral regurgitation grade was higher in the control group than in the group with the double row of sutures at 1.6 ± 0.9 vs 0.7 ± 0.3 (P = 0.0003). Annulus diameter reduction was less pronounced in the control group when compared with the group with the double row of sutures, both in the parasternal long-axis: 29.3 ± 3 vs 26.3 ± 3 mm (P = 0.0003) and in apical four-chamber views: 31 ± 3 vs 28 ± 2 mm (P = 0.003). Leaflet tethering indices were greater in the control group than in the group with the double row of sutures: tenting area: 1.42 ± 0.3 vs 1.1 ± 0.5 cm(2) (P = 0.002), anterior leaflet angle: 33 ± 3° vs 28 ± 5° (P = 0.0009) and posterior leaflet angle: 110 ± 13° vs 80 ± 11° (P = 0.0001). Left ventricular function parameters were not statistically different among the two groups.


CONCLUSIONS
A double row of overlapping sutures for attaching the prosthetic ring in downsizing annuloplasty is more efficient in narrowing the mitral annulus than the conventional technique in ischaemic mitral repair. Even in high-risk patients whose leaflets were severely tethered on echocardiography, it almost eliminated the risk of MR recurrence in this study.
Department of Cardiovascular Surgery, University Campus Bio-Medico, Rome, Italy Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint Denis, France.
Francesco
F
Nappi
Department of Cardiovascular Surgery, University Campus Bio-Medico, Rome, Italy.
Cristiano
C
Spadaccio
Department of Cardiovascular Surgery, University Campus Bio-Medico, Rome, Italy.
Massimo
M
Chello
Department of Cardiovascular Surgery, University Campus Bio-Medico, Rome, Italy.
Mario
M
Lusini
Department of Cardiothoracic Surgery, Hôpital Pitié-Salpétrière, Paris, France c.acar@psl.aphp.fr.
Christophe
C
Acar
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D013536:Suture Techniques / Q000009:adverse effects / Q000706:statistics & numerical data*; D016896:Treatment Outcome
Ischaemic mitral valve insufficiency; Mitral annuloplasty; Mitral valve repair