The choice of mitral annuloplastic ring-beyond "surgeon's preference".

Abstract

Annuloplasty is a fundamental component in mitral valve repair. According to Carpentier’s original concepts, an annuloplastic ring is essential for the following three reasons: (I) to restore the size and shape of the native annulus; (II) to prevent future annular dilatation; and (III) to provide functional annular support. Logically, Carpentier designed his annuloplastic ring to remodel the annulus into the shape it takes in the systolic phase (1). Because the entire mitral valvular structure experiences the highest stress during this phase, this particular configuration may restore maximal leaflet coaptation (1). Over the past two decades, although the choice of annuloplastic ring has been the focus of extensive investigation and debate, to date it still largely remains a matter of “surgeon’s preference” rather than an evidence-based selection. In fact, only a handful of prospective randomized clinical trials had ever been conducted and existing knowledge on this particular subject is far from conclusive (2).