title: Mitral valve repair using a semirigid ring: patient selection and early outcomes.
abstract: BACKGROUND
  Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair.
  
  
  METHODS
  We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative (n = 60) or functional (n = 6) mitral regurgitation had Memo 3D (n = 32) or Memo 3D ReChord (n = 34) rings implanted.
  
  
  RESULTS
  Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up.
  
  
  CONCLUSIONS
  Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China swan@cuhk.edu.hk.
authors.forename: Song
authors.initials: S
authors.lastname: Wan
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Alex Pw
authors.initials: AP
authors.lastname: Lee
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Saina
authors.initials: S
authors.lastname: Attaran
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Peter Sy
authors.initials: PS
authors.lastname: Yu
authors.affiliation: Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Sylvia Sw
authors.initials: SS
authors.lastname: Au
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Micky Wt
authors.initials: MW
authors.lastname: Kwok
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Rainbow Wh
authors.initials: RW
authors.lastname: Lau
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Randolph Hl
authors.initials: RH
authors.lastname: Wong
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Innes Yp
authors.initials: IY
authors.lastname: Wan
authors.affiliation: Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Siu-Keung
authors.initials: SK
authors.lastname: Ng
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Underwood
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene
keywords: Echocardiography; Mitral valve; Mitral valve annuloplasty; Mitral valve insufficiency; Prosthesis design; three-dimensional