Long-term outcomes of mitral valve repair with the Classic and Physio rings

Background: The Carpentier-Edwards semi-rigid Physio ring (PR) is considered an improvement of the rigid Classic ring (CR). Hence, the former is nowadays widely used in mitral valve (MV) repair. We sought to compare the long-term outcomes of MV repair with the CR and PR in degenerative mitral valve disease (MVD). Methods: In a computerized registry of our institution, 306 patients were found to have had MV repair with the CR (139 patients) or PR (167 patients) between 2005 and 2015. Fifteen of them had concomitant tricuspid valve repair. Out of the total number, 92 patients (30.1%) were diagnosed with Barlow's disease and 214 patients (69.9%) with fi broelastic defi ciency. Patients in the two ring groups had similar demographic and echocardiographic characteristics. Results: There were 4 (1.3%) operative mortalities. Mean follow-up time was 107.4 } 13.2 months. Left ventricular end-diastolic and end-systolic diameters signifi cantly improved in both groups, but were comparable between groups. Survival at ten years was 84.6% (93.1% in CR and 91.5% in PR; p = 0.177) and freedom from recurrent MR > 2+ was 74.5% (88.2% in CR and 86.3% in PR; p = 0.110) at 10 years. Reoperations for repair failure were eight in CR and six in PR. By Cox regression analysis, Barlow's disease, preoperative MR = 4+ and chordal shortening were predictors of repair failure. Old age (≥70 years), NYHA functional class IV and pulmonary artery systolic pressure (≥40 mmHg) were predictors of poor survival by univariate analysis. Conclusions: Long-term outcomes of repair for degenerative MVD with the Classic and Physio rings are comparable. Artifi cial chordal implantation should be used instead of chordal shortening for degenerative chordae. Left ventricular outfl ow tract obstruction in Barlow's disease can be completely avoided by the use of large rings. © 2020 Czech Society of Cardiology Z.S. All rights reserved.