# Early Outcomes of the PhysioFlex Semi-Rigid Open Annuloplasty Ring: A Minimally Invasive Mitral Valve Repair Cohort Analysis

## TL;DR

This study evaluates a new semi-rigid annuloplasty ring for minimally invasive mitral valve repair, showing promising early clinical outcomes.

## Contribution

The study introduces and evaluates the PhysioFlex semi-rigid open ring as a novel alternative for mitral valve repair.

## Key findings

- The PhysioFlex ring was associated with no residual mitral regurgitation greater than mild in all patients.
- Median hospitalization time was 7 days with low in-hospital mortality (0.7%).

## Abstract

Objectives: New generations of annuloplasty rings are designed to combine structural support with enhanced flexibility, allowing for better adaptation to the dynamic nature of the mitral annulus. This study investigated the early clinical and echocardiographic outcomes of minimally invasive mitral valve repair (MI-MVr) with a new semi-rigid open ring (PhysioFlex, annuloplasty ring, Edwards Lifesciences, Irvine, CA, USA). Methods: A total of 150 consecutive patients who underwent MI-MVr for severe degenerative mitral regurgitation (DMR) using the PhysioFlex annuloplasty ring between June 2021 and April 2024 were included in the study. Preoperative, intraoperative, and postoperative data were collected for the entire population. A three-dimensional mitral valve reconstruction analysis was performed across the entire cohort using a semi-automated software package (4D Mitral Valve Analysis; Tomtec Imaging Systems, Munich, Germany). Results: The median age was 59 (50–67) years and 25.3% patients were female. The median Euroscore II and left ventricular ejection fraction were 0.72 (0.56–0.99) and 60% (55–65), respectively. The median implanted ring size was 34 mm (32–36). The entire cohort was discharged with no residual mitral regurgitation greater than mild and a median mean transmitral pressure gradient of 2.4 mmHg (2–3). The median hospitalization time was 7 days (6–11) and in-hospital mortality occurred in 1 (0.7%) patient. Conclusions: MI-MVr was safely performed using the novel semi-rigid partial PhysioFlex ring in the DMR patient cohort with favorable early results. The PhysioFlex annuloplasty ring may be used as an alternative to complete rings in MI-MVr. Further research is needed to conduct comparisons with other currently available annuloplasty rings.