The influence of saddle-shaped annuloplasty on leaflet curvature in patients with ischaemic mitral regurgitation.
Publication/Presentation Date
9-1-2012
Abstract
OBJECTIVES: Reports indicate that repair procedures for ischaemic mitral regurgitation (IMR) are less durable than previously thought. Repair failure has been shown to be stress related. Leaflet curvature is the major determinant of valve stress. Theoretical and animal experiments have shown that saddle-shaped annuloplasty optimizes leaflet curvature when compared with standard flat ring annuloplasty. Despite this, the influence of the ring shape on leaflet curvature has not been described in patients with IMR. This study uses real-time three-dimensional echocardiography (rt-3DE) to assess the influence of the ring shape on leaflet curvature.
METHODS: Rt-3DE was performed in 21 patients with IMR after placement of either a flat (n = 10, CE-Physio, Edwards) or saddle-shaped (n = 11, Profile 3D, Medtronic) annuloplasty ring. A combination of commercially available and customized software was used to measure multiple leaflet curvature parameters across all regions of the mitral valve.
RESULTS: Independently of the shape of the annuloplasty ring, all patients were subject to the same degree of annular undersizing. Patients who received saddle-shaped annuloplasty rings had greater leaflet curvature in all six mitral valve leaflet regions (A1 = 0.36 ± 0.10, A2 = 0.53 ± 0.13, A3 = 0.47 ± 0.13, P1 = 0.35 ± 0.23, P2 = 0.53 ± 0.34, P3 = 0.42 ± 0.20 cm(-2)) compared with patients who received flat annuloplasty rings (A1 = 0.16 ± 0.11, A2 = 0.18 ± 0.09, A3 = 0.16 ± 0.11, P1 = 0.20 ± 0.17, P2 = 0.21 ± 0.11, P3 = 0.18 ± 0.13 cm(-2)). These differences were statistically significant in all regions except the P1 region.
CONCLUSIONS: Saddle-shaped annuloplasty rings increase leaflet curvature compared with flat rings in patients with IMR. As a result, saddle-shaped annuloplasty may decrease leaflet stress and potentially increases the durability of the repair in patients with IMR.
Volume
42
Issue
3
First Page
493
Last Page
499
ISSN
1873-734X
Published In/Presented At
Vergnat, M., Levack, M. M., Jassar, A. S., Jackson, B. M., Acker, M. A., Woo, Y. J., Gorman, R. C., & Gorman, J. H., 3rd (2012). The influence of saddle-shaped annuloplasty on leaflet curvature in patients with ischaemic mitral regurgitation. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 42(3), 493–499. https://doi.org/10.1093/ejcts/ezs040
Disciplines
Medicine and Health Sciences
PubMedID
22351705
Department(s)
Department of Medicine, Cardiology Division
Document Type
Article