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Alain F. Carpentier
Arrigo Lessana
Emre Belli
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Didier F. Loulmet
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Ann Thorac Surg 1995;60:1177-1186
© 1995 The Society of Thoracic Surgeons


Articles

The "Physio-Ring": an advanced concept in mitral valve annuloplasty

MD, PhD Alain F. Carpentiera,b,*, MD Arrigo Lessanaa,b, MD John Y.M. Rellanda,b, MD Emre Bellia,b, MD Serban Mihaileanua,b, MD Alain J. Berrebia,b, MD Evelyn Palskya,b, MD Didier F. Loulmeta,b

a Department of Cardiovascular Surgery and Organ Transplantation, Hôpital Broussais, Paris, France
b Hôpital Européen de Paris-La Roseraie, Aubervilliers, France

* Address reprint requests to Dr Carpentier, Cardiovascular Surgery Department, Hôpital Broussais, 96, rue Didot, 75014 Paris, France.

Background.: A new annuloplasty ring has been developed with the aim of adding flexibility to the remodeling annuloplasty concept. Here we report its clinical use with special emphasis on segmental valve analysis and valve sizing.

Methods.: From October 1992 through June 1994, 137 patients aged 4 to 76 years (mean age, 49.1 years) were operated on. The main causes of mitral valve insufficiency were degenerative, 90; bacterial endocarditis, 15; and rheumatic, 13. The indication for operation was based on the severity of the mitral valve insufficiency (90 patients were in grade III or IV) rather than on functional class (60 patients were in class III or IV). At echocardiography 6 patients had normal leaflet motion (type I), 119 leaflet prolapse (type II), and 12 restricted leaflet motion (type III). Surgical repair was carried out using Carpentier techniques of valve reconstruction. In 3 patients, inadequate ring sizing was responsible for systolic anterior motion of the anterior leaflet diagnosed by intraoperative echo. The valve was replaced in 2 patients. There were three hospital deaths, no late deaths, one reoperation for recurrent mitral valve insufficiency due to chordal rupture 1 month after repair, one reoperation for atrial thrombus formation 5 months after repair, one anticoagulant-related hemorrhage, and one thromboembolic episode.

Results.: Mid-term follow-up between 6 and 18 months was available in 94 patients. Echocardiography showed trivial or no regurgitation in 93.2% of the patients and minimal regurgitation in 6.8%. The average transmitral diastolic gradient was 3.55 ± 1.93 mm Hg. Left ventricular end-systolic diameter and volume decreased postoperatively, demonstrating an improved left ventricular function.

Conclusions.: This preliminary experience has provided promising results and allowed us to define the indications of the Physio-Ring versus the classic ring. It has also shown that valve sizing and proper ring selection are of primary importance.




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Flexible posterior mitral annuloplasty: five-year clinical and Doppler echocardiographic results
Ann. Thorac. Surg., November 1, 1998; 66(5): 1692 - 1697.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
J.-F. G. Fuzellier, S. M. Chauvaud, P. Fornes, A. J. Berrebi, P. S. Lajos, P. Bruneval, and A. F. Carpentier
Surgical management of mitral regurgitation associated with marfan's syndrome
Ann. Thorac. Surg., July 1, 1998; 66(1): 68 - 72.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
D. F. Loulmet, A. Carpentier, P. W. Cho, A. Berrebi, N. d'Attellis, C. B. Austin, J.-P. Couetil, and P. Lajos
Less invasive techniques for mitral valve surgery
J. Thorac. Cardiovasc. Surg., April 1, 1998; 115(4): 772 - 779.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
A. Dall'Agata, M. A. Taams, P. M. Fioretti, J. R. T. C. Roelandt, and L. A. Van Herwerden
Cosgrove-Edwards Mitral Ring Dynamics Measured With Transesophageal Three-Dimensional Echocardiography
Ann. Thorac. Surg., February 1, 1998; 65(2): 485 - 490.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
E. M. Lee, L. M. Shapiro, and F. C. Wells
Midterm Results of Mitral Valve Repair With the Sculptor Annuloplasty Ring
Ann. Thorac. Surg., May 1, 1997; 63(5): 1340 - 1345.
[Abstract] [Full Text]


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J. Thorac. Cardiovasc. Surg.Home page
A. F. Carpentier, M. Pellerin, J.-F. Fuzellier, and J. Y. M. Relland
EXTENSIVE CALCIFICATION OF THE MITRAL VALVE ANULUS: PATHOLOGY AND SURGICAL MANAGEMENT
J. Thorac. Cardiovasc. Surg., April 1, 1996; 111(4): 718 - 730.
[Abstract] [Full Text]




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