title: Treatment of Mitral Valve Regurgitation with an Open Rigid Annuloplasty Ring.
abstract: Annuloplasty constitutes a major operative step in the surgical treatment of degenerative mitral valve regurgitation (MR). The choice of ring structure to obtain an adequate remodeling of the mitral orifice and to respect the motion of the mitral apparatus remains the subject of debate. The study aim was to determine the clinical and echocardiographic outcome when using an open rigid ring to treat MR.
  
  
  
  A total of 129 patients (94 men, 35 women; mean age 64.5 ± 11.7 years) was referred to the authors' institution between 1997 and 2011 for the surgical management of severe MR. Patients were implanted with a modified open rigid annuloplasty ring, and also underwent anterior and/or posterior leaflet repair. The occurrence of any major adverse cardiac and cerebrovascular event (MACCE) was considered as the primary end-point and was retrospectively collected along with echocardiographic data.
  
  
  
  The perioperative mortality was 1.6%. The cardiopulmonary bypass and cross-clamp times were 73.3 ± 17.1 min and 51.6 ± 13.0 min, respectively. There was one case (0.7%) of postoperative mitral systolic anterior motion. During a mean follow up period of 6.0 ± 3.1 years, 25 patients (19%) presented a MACCE. MACCE-free survival at one, five and 10 years was respectively 96.8%, 91.3%, and 61.4%. Preoperative determinants of MACCE were paroxysmal/persistent atrial fibrillation (HR 2.53; 95% CI: 1.06-6.01; p = 0.035) and age (HR 1.05; 95% CI: 1-1.09; p = 0.035).
  
  
  
  Mitral valve repair with an open-rigid ring offers satisfactory long-term results with a low rate of subsequent MR recurrence and reintervention. Preoperative AF is the main determinant of long-term adverse outcome.
authors.affiliation: Department of Cardiology, University Hospital of Nancy, Vandoeuvre les Nancy, France. Electronic correspondence: c.venner@chru-nancy.fr.
authors.forename: Clement
authors.initials: C
authors.lastname: Venner
authors.affiliation: Department of Cardiology, University Hospital of Nancy, Vandoeuvre les Nancy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Huttin
authors.affiliation: Department of Cardiac Surgery, University Hospital of Nancy, Vandoeuvre les Nancy, France.|School of Surgery, University of Lorraine, Vandoeuvre les Nancy, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fiore
authors.affiliation: Department of Cardiac Surgery, University Hospital of Nancy, Vandoeuvre les Nancy, France.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sirbu
authors.affiliation: Department of Cardiac Surgery, University Hospital of Nancy, Vandoeuvre les Nancy, France.|School of Surgery, University of Lorraine, Vandoeuvre les Nancy, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Villemot
authors.affiliation: Department of Cardiac Surgery, University Hospital of Nancy, Vandoeuvre les Nancy, France.|School of Surgery, University of Lorraine, Vandoeuvre les Nancy, France.
authors.forename: Juan-Pablo
authors.initials: JP
authors.lastname: Maureira
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; 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 / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome