Surgeon Q&A: What Should Patients Know About Mitral Valve Repair Rings?
By Adam Pick on October 15, 2017
At the recent “Ask Me Anything” session at the Heart Valve Summit in Chicago, I received a great question from Maria about heart valve repair rings (also known as annuloplasty rings). Maria wrote to me, “Hi, Adam, two questions. Could you please ask the surgeons about annuloplasty rings, and which styles and brands have the best track record for long-term effectiveness following a mitral valve repair surgery? Thanks! Maria”
To answer this question, I was very fortunate to interview Dr. Steve Bolling from Michigan Medicine in Ann Arbor, MI. So you know, Dr. Bolling is a mitral valve repair guru who performs about 350 mitral procedures a year. That said, Dr. Bolling was the perfect person to answer Maria’s question. Here’s what Dr. Bolling shared with me.
Many thanks to Maria for her question. And, a special thanks to Dr. Steve Bolling and the entire team at Michigan Medicine who have been such fantastic supporters of our patient community over the years. That means you Sharron, Monica and Carolyn!
Keep on tickin!
P.S. For the hearing impaired members of our community, I have provided a written transcript of the video with Dr. Bolling below.
Adam Pick: Hi, everybody. It’s Adam. We are at the Heart Valve Summit in Chicago, Illinois. I’m here with Dr. Steve Bolling, who is a cardiac surgeon at Michigan Medicine in Ann Arbor, Michigan. Steve, thanks for being with me.
Steve Bolling: Adam, thanks for having me again.
Adam Pick: As you may know, Steve, we’re answering the questions from our community that came in on HeartValveSurgery.com, Facebook, all over the internet. We have a great question that came in from Maria Gapinski. She asks, “Hi, Adam, two questions. Could you please ask the surgeons about annuloplasty rings, and which styles have the best track record for long-term effectiveness following a mitral valve repair surgery?
Dr. Steven Bolling – Mitral Valve Specialist
Steve Bolling: Adam, that is a really great question. Maria, we get that question not only from patients but from other surgeons. The answer is it almost doesn’t matter. Here’s what I say, it’s not the ring, it’s the ringer. It’s the surgeon who puts it together. Yes, I think for some certain types of mitral disease – such as functional disease, where it’s really disease of the heart – I think you need to put a small rigid ring on that patient, and most groups have gone to that. For garden variety degenerative disease – a floppy mitral valve, myxomatous disease – I don’t think it matters.
Here’s what I think matters. One, that you re-establish the Roman arch of that mitral valve, so that it locks up and closes. This, that’s how big your mitral annulus should be. Use a ring that will bring it down to that size. Now, there are subtleties of a complete ring or a partial ring, a flexible ring, and so on like that, but there’s really been no study that shows that one is better than the other. It’s far more important that you pick your surgeon rather than pick your ring.
Adam Pick: Steve, let’s dig into that. If you’re Maria, if you’re a patient diagnosed with mitral regurgitation, you’ve got a problem, how do you find the right ringer? What are the questions you ask to determine that as a patient?
Steve Bolling: You need to find the right ringer, that is, the right surgeon. One of the most important things as in anything in life, the more you do of something, the better you are at it. Ask them what has been their experience with this particular type of mitral disease. Ask them, be very blunt, say how many of these have you done?
Adam Pick: Steve, as always, thanks for your help here. I know that helped Maria. I know it helped our community. Helps me as always. Thanks again for all the great things you and your team are doing at Michigan Medicine.
Steve Bolling: Thanks, Adam. Thanks for having us.