Mitral valve repair: Is a flexible, closed implant superior to a semirigid open implant regarding to overall survival and quality of life?

Objectives: Mitral valve repair is since several years the gold standard in surgery of mitral valve isufficiency with very good long term results. But there are still discussions about the different annuloplasty tools. We studied mitral annuloplasty with a flexible closed implant and with a semirigid open implant.

Methods: In this retrospective cohort study we analyzed 364 patients with mitral regurgitation who underwent isolated mitral valve repair from january 1996 to december 2008. 127 Patients got a flexible ring and 237 patients got a semirigid band. Preoperative and postoperative echocardiography examination was done. Mortality and life tables were studied. Parameters that effects survival were evaluated with Cox regression analysis. P<0.05 was considered statistical significant. Quality of life test was performed with the Nottingham Health Profile.

Results: Mean postoperative follow up was 59.3±38.5(0–166.3) months. There were no preoperativ significant differences between the two study groups. The mean age was 63±11.1 (29.8–85.1) years and there were 58.4% males. A reoperation was performed in 9.4% with a flexible closed implant and in 2.5% with a semirigid open implant. The 30 days survival was 97.6% with the flexible closed implant and 99.2% with the semirigid open implant. The 12, 24, 60 and 96 months survival was 93.9%, 92.2%, 83.1% and 80.1% with the flexible closed implant and 97.8%, 96.9%, 93.3% and 93.3% with a semirigid open implant respectively. Risk factors for intermediate term mortality were age, emergency, early postoperative arrhythmia, postoperative EF and type of implant. The semirigid open implant has an sigificant better intermediate term outcome than a flexible closed implant (p=0.015). There were no differences between the implants concerning quality of life.

Conclusions: Mitral valve repair with a semirigid open implant has a significant better intermediate term outcome and a lower reoperation rate compared to a flexible closed implant. But there are no differences regarding the quality of life. Studies with new rigid closed rings should be performed.