DOI: 10.25881/BPNMSC.2020.25.11.003


Sidiki A.I.1, 2, Lishchuk A.N.2, Fajbushevich A.G.1

1 People’s Friendship University of Russia, Moscow

2 FSBI «3 Central Vishnevsky Military Hospital of the Defense of the Russian Federation» vil. Novy-hospital, p/b Arkhangelskoe, Krasnogorsk district, Moscow region


Background: for the past several decades, valve repair has become the standard method of treating mitral valve insufficiency because it improves left ventricular geometry and function and increases long-term patient survival. Stabilizing the mitral annulus with a ring is an integral part of mitral valve reconstruction. There have been several discussions and arguments about the advantages and disadvantages of the many available annuloplasty devices.

Aims: we compared the early and long-term results of mitral valve reconstruction with rigid and semi-rigid annuloplasty rings in degenerative disease.

Materials and methods: between January 2015 and December 2019, 152 were randomized into one of the two groups of repair of degenerative mitral valves: group RR- mitral valve repair with a rigid annuloplasty ring (76 patients), group SR- mitral valve repair with a semi-rigid annuloplasty ring (76 patients). The patients’ mean age was 58.7±9.0 in RR and 62.5±8.9 years in SR. The groups did not differ in terms of sex, age, height, weight, preoperative NYHA functional class and cardiac rhythm.

Results: two patients in group RR who underwent valve replacement due to initial repair failure were excluded from the study. There were 3 instances of hospital mortality. The mean follow-up time was 59.4±6.1 months. In both groups, left ventricular ejection fraction, end diastolic volume, stroke volume, left ventricular and left atrial sizes were significantly reduced in the early postoperative period as compared to the preoperative values. The groups had similar characteristics, preoperative and long-term cardiac parameters. At 5-years of follow-up, recurrent mitral regurgitation was of grade 1.0±0.5 and 1.0±0.7 in RR and SR respectively. Freedom from redo surgery was 97.3% in RR and 100% in SR, from recurrent regurgitation ≥2/4 was 74.3% in RR and 69.75% in SR. Survival was 98.6% and 97.4 in RR and SR respectively. There were no instances of myocardial infarction, stroke, hemorrhage, infective endocarditis and any kind of thromboembolic event. Only two patients in RR had documented repair failure.

Conclusions: we found out in this study that mitral valve reconstruction with rigid and semi-rigid annuloplasty rings have comparable early and long-term clinical and echocardiographic results.

Keywords: mitral regurgitation, mitral valve repair, rigid ring, semi-rigid ring.


1. Nazarov VM, Zheleznev SI, Zheltovskiy YV, et al. Mitral valve repair using different annuloplasty rings in patients with degenerative mitral valve disease. Sibirskiy meditsinskiy zhurnal. 2013;152(8):31–38.

2. Sidiki AI, Lishuk AN, Faybushevich AG, Ivanov DV. A comparison of pericardial and prosthetic annuloplasty in mitral valve repair. Journal of new medical technologies. 2020;72(3):1–4. Doi: 10.24411/2075-4094-2019-16436.

3. Esion GA, Lishchuk AN, Koltunov AN, Karpenko IG. An improvement of results of prosthetics aortic valve to seniors by using an implant «ON-X». Journal of new medical technologies. 2018;102(5):1–10.

4. Nkomo VT, Gardin JM, Skelton TN. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(3):1005–1011.

5. Nazarov VM., Afanasev AV, Demin II. Korreksia mitralnaya nedostatochnost pri bolezni Barlou. Patologia krovoobrasheniya i kardiochirurgia. 2014;82(1):70–73.

6. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N. Engl. J. Med. 2005;352(5):875–883.

7. Chauvaud S, Fuzellier JF, Berrebi A. Long term (29 years) results of reconstructive surgery in rheumatic mitral valve insufficiency. Circulation. 2001;104(1):12–15.

8. Lorusso R, Borghetti V, Totaro P, et al. The double-orifice technique for mitral valve reconstruction: predictors of postoperative outcome. Eur J Cardiothorac Surg. 2001;20(3):583–589.

9. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am CollCardiol. 2008;52(4):1–142.

10. Brown ML, Schaff HV, Li Z, et al. Results of mitral valve annuloplasty with a standard-sized posterior band: Is measuring important. J Thorac Cardiovasc Surg. 2009;138(3):886–891.

11. Enriquez-Sarano M, Schaff HV, Orszulak TA, et al. Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. Circulation. 1995;91(2):1022–1028.

12. Fedak PWM, McCarthy PM, Bonow RO. Evolving Concepts and Technologies in Mitral Valve Repair. Circulation. 2008;117:963–974.

13. Bakhshandeh AR, Salehi M, Radmehr H. Autologous rings vs flexible prosthetic ring for ischemic mitral regurgitation. Asian Cardiovasc. Thorac. Ann. 2010;18:127–130.

14. Vohra HA, Whistance RN, Bezuska L, Livesey SA. Initial experience of mitral valve repair using the Carpentier-Edwards Physio II annuloplasty ring. Eur J Cardiothorac Surg. 2011;39:881–885.

15. Anyanwu AC, Adams DH. Etiologic classification of degenerative mitral valve disease: Barlow’s disease and fibroelastic deficiency. Thorac and cardiovasc. surg. 2007;19:90–96.

16. Cosgrove DM, Arcidi JM, Rodriguez L, et al. Initial experience with the Cosgrove-Edwards annuloplasty system. Ann Thorac Surg. 1995;60:499–503.

17. Flameng W, Meuris B, Herijgers P, Herregods M. Durability of mitral valve repair in Barlow disease versus fibroelastic deficiency. J Thorac Cardiovasc Surg. 2008;135:274–282.

18. Lange R, Guenther T, Kiefer B, et al. Mitral valve repair with the new semirigid partial Colvin–Galloway Future annuloplasty band. J ThoracCardiovasc Surg. 2008;135:1087–1093.

19. Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. European heart journal. 2010;31:1958–1967.

20. Camm AJ, Lip GYH, De Caterina R, et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2012;33(19):2451–2496.

For citation

Sidiki A.I., Lishchuk A.N., Fajbushevich A.G. A comparison of rigid and semi-rigid annuloplasty rings in mitral valve repair. Bulletin of Pirogov National Medical & Surgical Center. 2020;3-2(15):15-19. (In Russ.)