Saddle-shape annuloplasty increases mitral leaflet coaptation after repair for flail posterior leaflet.
Publication/Presentation Date
9-1-2011
Abstract
BACKGROUND: The primary goal of surgical mitral repair is the reestablishment of normal leaflet coaptation. Surgical techniques that maintain or restore leaflet geometry promote leaflet coaptation. Recent 3-dimensional (3D) echocardiographic studies have shown that saddle-shaped annuloplasty has a salutary influence on leaflet geometry. Therefore we hypothesized that saddle-shaped annuloplasty would improve leaflet coaptation in cases of repair for flail posterior leaflet segments.
METHODS: Sixteen patients with flail posterior segment and severe mitral regurgitation had valve repair using standard techniques. Eight patients received saddle-shaped annuloplasty and 8 patients received flat annuloplasty. Real-time 3D transesophageal echocardiography was performed before and after repair. Images were analyzed using custom software to calculate mitral annular area (MAA), septolateral dimension (SLD), intercommissural width (CW), total leaflet area (TLA), and leaflet coaptation area (LCA).
RESULTS: Postrepair MAA (flat, 588.6±26.5 mm2; saddle, 628.0±35.3 mm2; p=0.12) and TLA (flat, 2198.5±151.6 mm2; saddle, 2303.9±183.8 mm2; p=0.67) were similar in both groups. Postrepair LCA was significantly greater in the saddle group than in the flat group (226.8±24.0 mm2 and 154.0±13.0 mm2, respectively; p=0.02).
CONCLUSIONS: Real-time 3D echocardiography and novel imaging software provide a powerful tool for analyzing mitral leaflet coaptation. When compared with flat annuloplasty, saddle-shaped annuloplasty improves LCA after mitral valve repair for severe mitral regurgitation secondary to flail posterior leaflet segment. Use of saddle-shaped annuloplasty devices may increase repair durability.
Volume
92
Issue
3
First Page
797
Last Page
803
ISSN
1552-6259
Published In/Presented At
Vergnat, M., Jackson, B. M., Cheung, A. T., Weiss, S. J., Ratcliffe, S. J., Gillespie, M. J., Woo, Y. J., Bavaria, J. E., Acker, M. A., Gorman, R. C., & Gorman, J. H., 3rd (2011). Saddle-shape annuloplasty increases mitral leaflet coaptation after repair for flail posterior leaflet. The Annals of thoracic surgery, 92(3), 797–803. https://doi.org/10.1016/j.athoracsur.2011.04.047
Disciplines
Medicine and Health Sciences
PubMedID
21803330
Department(s)
Department of Medicine, Cardiology Division
Document Type
Article