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The Journal of Cardiovascular Surgery 2022 August;63(4):529-35

DOI: 10.23736/S0021-9509.22.11874-4


lingua: Inglese

Physio and Physio II rings: beyond the annular physiology

Abubakari I. SIDIKI 1 , Anastasia A. AKULOVA 1, Marina H. HUSSEIN 1, Malik K. AL-ARIKI 2, Vladislav V. DONSOV 3, Mikhail A. ILUHIN 4, Andrei A. LIMESHKIN 4, Vadim A. ANANKO 4

1 Department of Cardiothoracic Surgery, People’s Friendship University of Russia (RUDN-University), Moscow, Russia; 2 Department of Surgery, People’s Friendship University of Russia (RUDN-University), Moscow, Russia; 3 Department of Cardiac Surgery, M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow, Russia; 4 Cardiovascular Center, FSBI 3 Central Vishnevsky Hospital, Moscow, Russia

BACKGROUND: Engineering of the Carpentier-Edwards Physio (PR-I) and Physio II (PR-II) rings (Edwards Lifesciences Corp., Irvine, CA, USA) combines flexibility with remodeling. PR-II is considered an improvement of PR-I, as it boasts of an improved shape, a double saddle, and a sewing cuff that reduces tension on sutures. Beyond the superior effect of the PR-II on the annular physiology, it has not been proven to be clinically better than the PR-I. This study compares the long-term clinical outcomes of MV repair for degenerative disease with these rings.
METHODS: From 2004 to 2020, MV repair with Physio ring annuloplasty (group PR-I) was performed in 231 patients, and with Physio-II ring annuloplasty (group PR-II) in 255 patients. A propensity score-matching analysis was used to pair 104 in each group. Primary outcome was recurrent MR≥3 and secondary outcomes were long-term survival, cardiac death, and MV-related events (MVREs). The 15-year follow-up data were complete in 97.3% of patients.
RESULTS: There were no differences in 15-year freedom from recurrent MR (P=0.721), survival and cardiac death between the matched groups (P=0.693 and P=0.135, respectively). MVREs, including cardiac death, pacemaker implantation, thromboembolism, bleeding, and reoperation were also similar between the matched groups (P=0.603). However, 5-year recurrent MR was significantly higher in PR-I than in PR-II (P=0.010). Multivariate analysis showed Barlow’s disease and preoperative MR≥3 as risk factors for late MR recurrence.
CONCLUSIONS: Type of annuloplasty rings did not influence long-term clinical outcomes. Better annular dynamics seen in PR-II annuloplasty does not translate into superior freedom from recurrent MR.

KEY WORDS: Mitral valve; Mitral valve annuloplasty; Cardiovascular system

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