Does the Kalangos biodegradable ring promote annular remodelling and preserve the growth potential following mitral valve repair for congenital mitral regurgitation?

  • Dr Sivakumar Sivalingam, National Heart Institute, Kuala Lumpur, Malaysia
  • Dr Jeswant Dillon, National Heart Institute, Kuala Lumpur, Malaysia
  • Dr Mazeni Alwi, National Heart Institue, Kuala Lumpur, Malaysia
  • Dr Azhari Yakub, National Heart Institute, Kuala Lumpur, Malaysia
  • Prof Afksendiyos Kalangos, University Hospital of Geneva, Geneva, Switzerland

    • Objectives:
    The Kalangos biodegradable ring in experimental studies has been shown to promote annular remodelling and preserve annular growth potential. In this study we report the feasibility of this concept when implanted as concomitant annuloplasty for mitral valve repair in a pediatric population.

    Methods:
    Between January 2006 and December 2007, 20 patients with a median age of 3 years(6 months - 13 years)underwent mitral valve repair with concomitant annuloplasty using the biodegradable ring. Regurgitation was due to annular dilatation in 3(15%), prolapsed leaflets in 16(85%) and restrictive leaflet motion in 1(5%) patients. Pre-operative indexed mitral valve diameter and Z-values were compared with those obtained at follow-up. The annular diameter in the immediate post-operative period and follow-up were compared to assess the growth potential of the annulus.

    Results:
    There were no early deaths. The median follow-up period was 22.5 months. At follow-up regurgitation grades were none in 6, mild in 13 and moderate in 1 patients. There were no significant changes in the mean gradient between the immediate post-operative period and follow-up (4.47+/-1.41mmHg Vs. 3.94+/-1.61mmHg. p-0.179). Annuloplasty resulted in significant reduction of the indexed mitral valve diameter 40.28+/-12.08mm/m2 to 18.70+/2.98mm/m2(p<0.001) and Z-value 0.80+/-1.01 to -0.74+/-0.98(p<0001). There was a significant increase in the annular diameter by 7.9% between immediate post-operative period and follow-up(17.41+/-2.9mm to 18.70+/-2.9mm)(p<0.0001)

    Conclusion:
    Annuloplasty with Kalangos biodegradable ring has demonstrated to optimize the results of mitral valve repair in pediatric patients. It has further shown to promote annular remodelling and preserve the growth potential of the native annulus.