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Outcomes of loop technique with ring annuloplasty: a > 10-year experience

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Abstract

Objective

We assessed the long-term outcomes of the loop technique with ring annuloplasty for mitral regurgitation from our > 10-year experience.

Methods

We retrospectively reviewed 362 patients who underwent the loop technique with ring annuloplasty via median sternotomy or right mini-thoracotomy for mitral regurgitation. The median follow-up duration was 4.1 years (interquartile range 2.3–5.8 years).

Results

This study involved 147 women and 215 men (median age, 66.5 years). Mitral regurgitation was caused by Barlow’s disease in 27 patients. Seven patients required reoperations (recurrent regurgitation caused by technical issues, n = 3; progression of degenerative disease, n = 4). The 5- and 10-year cumulative incidences of reoperation considering death as the competing event were 1.4% and 5.4%, respectively. The 5- and 10-year postoperative cumulative incidences of moderate-to-severe recurrent mitral regurgitation were 4.7% and 13.0%, respectively. Residual regurgitation ≥ mild (hazard ratio, 6.99; 95% confidence interval, 1.520–32.12; P = .012) was an independent risk factor for reoperation. The independent risk factors for moderate-to-severe recurrent regurgitation were residual regurgitation ≥ mild (hazard ratio, 9.60; 95% confidence interval, 3.042–30.31; P < .001) and the loop-in-loop technique (hazard ratio, 3.40; 95% confidence interval, 1.058–10.90; P = .040). The median mean pressure gradient was sustained at almost 3.5 mmHg for > 7 years.

Conclusions

The loop technique with ring annuloplasty provided excellent results with good hemodynamics beyond the mid-term. Residual regurgitation ≥ mild and the loop-in-loop technique may not be preferable for durable outcomes.

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Abbreviations

BMI:

Body mass index

BSA:

Body surface area

CI:

Confidence interval

EF:

Ejection fraction

Inf:

Infinity

IQR:

Interquartile range

LVDd:

Left-ventricular diastolic dimension

NYHA:

New York Heart Association

MV:

Mitral valve

MR:

Mitral valve regurgitation

PG:

Pressure gradient

ePTFE:

Expanded polytetrafluoroethylene

SAM:

Systolic anterior leaflet motion

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Acknowledgements

We thank Jane Charbonneau, DVM and Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

The authors received no commercial support, including for the device used during surgery.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Akimasa Morisaki, Yosuke Takahashi, Hiromichi Fujii, Yoshito Sakon & Toshihiko Shibata

  2. Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan

    Takashi Murakami

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  1. Akimasa Morisaki
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  2. Yosuke Takahashi
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  3. Hiromichi Fujii
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  4. Yoshito Sakon
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  5. Takashi Murakami
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  6. Toshihiko Shibata
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Correspondence to Akimasa Morisaki.

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Morisaki, A., Takahashi, Y., Fujii, H. et al. Outcomes of loop technique with ring annuloplasty: a > 10-year experience. Gen Thorac Cardiovasc Surg 70, 793–803 (2022). https://doi.org/10.1007/s11748-022-01804-8

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  • DOI: https://doi.org/10.1007/s11748-022-01804-8

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