Reply to Yurekli et al.

This is a response to the letter to the editor by Yurekli et al. [1], to the article by Hu X et al. [2]. We would like to thank Dr Yurekli for their appreciation involving in our contribution and further raising a constructive suggestion. We agree with them that increased annular diameter of the mitral valve is associated with deteriorated left ventricular functions. And we are aware of the fact that equalizing the ring sizes was not performed when comparing flexible ring with rigid ring. In fact, the size of annuloplasty ring dependent of mitral annulus is a indirect index representing the left ventricular geometry, which indeed stratifies risk in mitral regurgitation independently of, and more strongly than, mitral annulus or other potentially reversible risk factors. Then it is noted that the enrolled trials all balanced the patients' baseline characteristics with no significance in the left ventricular end-diastolic diameter or left ventricular end-systolic diameter. In addition, it is infeasible to enroll selected patients in order to equalizing the ring sizes between the two groups in random control trials, which could violate the principle of randomization. At last, in the pooling assessment, the heterogeneity used to judge the consistency of evidence in left ventricular performance was not deemed significantly. Hence, we continue to maintain that our data are valid and scientific.

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