annuloplasty

Annuloplasty is a surgical procedure aimed at repairing the annulus of a heart valve, typically to correct valvular regurgitation caused by dilation or deformation of the annulus. The goal is to restore the annulus to a normal size and shape so the valve leaflets can coapt properly, improving valve competence without replacing the valve.

The most common targets are the mitral and tricuspid valves, though annuloplasty can be applied to other valves as well. It is frequently performed as part of a valve repair procedure rather than valve replacement, particularly in functional or secondary valve disease where annular dilation contributes to leakage. Indications include mitral regurgitation due to annular dilation from left ventricular remodeling, functional tricuspid regurgitation, and rheumatic or degenerative disease where annular distortion contributes to incompetence.

Techniques involve placing an annuloplasty ring or band around the valve annulus to reduce and stabilize its size. Rigid, semi-rigid, and flexible rings are used, and choices include complete rings or partial bands depending on the valve and pathology. The sutures secure the device to the annulus, often in conjunction with repairs to leaflets or chordae and, if needed, subvalvular procedures.

In addition to surgical annuloplasty, percutaneous (transcatheter) annuloplasty devices have been developed for select patients, particularly those at high surgical risk. Outcomes generally include reduced or eliminated regurgitation and improved symptoms, but risks mirror major cardiac surgery and can include residual regurgitation, stenosis, bleeding, infection, and device-related complications. Durability varies by disease etiology and technique.