Long-term outcomes showed the reduction in hazard ratio of the ring method compared to the ringless method on re-TR grade (> 2) HR = 0.47 (95% CI, 0: 37 - 0.60, p < 0.001), NYHA (+ I) HR = 0.72 (95% CI, 0: 56 - 0.93, p = 0: 01), and PAPS is equal in hazard ratio between the 2 groups.