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J Thorac Cardiovasc Surg 2008;136:73-81
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Initial clinical experience with Myxo-ETlogix^_* mitral valve repair ring

P.M. McCarthy, MD^a,_*, E.C. McGee, MD^a, V.H. Rigolin, MD^b, Q. Zhao, MD^b, H. Subaius, MA^c, A.L. Huskin, RN^c, S. Underwood, RN^a, B.J. Kane, RDCS^b, I. Mikati, MD^b, G. Gang, MD^a, R.O. Bonow, MD^b

^a Bluhm Cardiovascular Institute, Division of Cardiothoracic Surgery, Northwestern Memorial Hospital, Chicago, Ill
^b Bluhm Cardiovascular Institute, Division of Cardiology, Northwestern Memorial Hospital, Chicago, Ill
^c Bluhm Cardiovascular Institute, Division of Clinical Trials Unit, Northwestern Memorial Hospital, Chicago, Ill

Received for publication June 15, 2007; revisions received December 21, 2007; accepted for publication February 12, 2008.

^_* Address for reprints: Patrick M. McCarthy, MD, Northwestern University, Division of Cardiothoracic Surgery, 201 E Huron St, Suite 11-140, Chicago, IL 60611-2908. (Email: pmccart{at}nmh.org).

Objective: Complexity of mitral valve repair for myxomatous disease has led to low adoption. We report initial experience with a new ring designed specifically for myxomatous disease, the Myxo-ETlogix (Edwards Lifesciences LLC, Irvine, Calif).

Methods: From March 15, 2006, through November 19, 2007, 129 patients underwent mitral valve surgery for pure myxomatous disease, and 124 valves (96.1%) were repaired. The Myxo-ETlogix ring was used in 100 cases and the Physio ring (Edwards) in 24. The Myxo-ETlogix design includes a 3-dimensional shape to reduce systolic anterior motion and a larger orifice to accommodate elongated leaflets and decrease need for sliding plasty. Direct mitral valve measurements were made. Sizing was based on A2 height, and choice of ring type was based on unresected leaflet heights.

Results: There was no operative mortality or lasting perioperative morbidity. The Myxo-ETlogix group had taller A2, P1, P2, and P3 leaflet segments than the Physio group (P .003). Only 1 sliding plasty was performed for asymmetry in the Myxo-ETlogix group. Predischarge and follow-up echocardiograms (n = 338 in 124 patients) disclosed transient nonobstructive chordal systolic anterior motion in 3 echocardiograms in 3 patients. No patients had 2+ or greater mitral regurgitation. At discharge, 5.7% had 1+ mitral regurgitation; this proportion was 17.3% at last follow-up (mean 6.1 ± 4.4 months).

Conclusion: In initial experience with the Myxo-ETlogix ring, nonobstructive systolic anterior motion has been rare and obstructive systolic anterior motion not observed. Ongoing prospective echocardiographic and clinical studies will elucidate the role of this etiology-specific ring.