Open Versus Closed Ring for the Repair of Degenerative MR: Is there a Difference?

Background: Mitral valve (MV) repair in degenerative mitral valve disease is known to be the superior option in surgery of the mitral valve. Whether we use one technique or another, it is believed that the usage of a ring to fixate the annulus is always necessary for optimizing the durability of the repair. There are several different ring types used in the repair of the mitral valve, the most popular are open band and closed semi-rigid d-shaped rings. Our interest was to find out whether there are differences in outcomes between the two types of rings.

Methods: From 2012 to 2018, 407 consecutive patients with degenerative mitral valve underwent mitral valve repair in our department with an open or closed ring included in the repair. In 283 patients we used an open band and in 124 patients we used a closed semi-rigid ring. In the closed ring group 17% of patients underwent leaflet resection as part of the repair compared to 12% in the band group (p=0156). All patients were prospectively followed and long term clinical and echocardiographic outcomes were compared and analyzed.

Results: There were no early deaths.

At a FU of up to 83 months the overall survival was 99% and 99% respectively for the open and closed ring groups (p=1.00). New York Heart Association assessment revealed freedom from function class III-IV of 95% in the open ring group versus 93% in the closed ring group (p= 0.249). Freedom from reoperation was 95% versus 89% in the open ring group and closed ring group respectively (p=0.049).

Late echocardiography revealed freedom from moderate or severe MR to be 88% versus 82% in the open ring group and closed ring group respectively (p=0.243).

Conclusions: In our experience, Mitral Valve repair with an open band and less tissue resection results in a trend of better freedom from re-operation and freedom from recurrent moderate or severe MR. longer follow-up is needed.