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Effects of different annuloplasty ring types on mitral leaflet tenting area during acute myocardial ischemia
Stanford University School of Medicine, Stanford, Calif.
Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland. (Stanford University School of Medicine, Stanford, Calif)
Rice University, Houston, Tex.
Stanford University School of Medicine, Stanford, Calif.
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2011 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 141, no 2, 345-353 p.Article in journal (Refereed) Published
Abstract [en]

Objective

The study objective was to quantify the effects of different annuloplasty rings on mitral leaflet septal-lateral tenting areas during acute myocardial ischemia.

Methods

Radiopaque markers were implanted along the central septal-lateral meridian of the mitral valve in 30 sheep: 1 each to the septal and lateral aspects of the mitral annulus and 4 and 2 along the anterior and posterior mitral leaflets, respectively. Ten true-sized Carpentier-Edwards Physio, Edwards IMR ETLogix, and GeoForm annuloplasty rings (Edwards Lifesciences, Irvine, Calif) were inserted in a releasable fashion. Marker coordinates were obtained using biplane videofluoroscopy with ring inserted at baseline (RING_BL) and after 90 seconds of left circumflex artery occlusion (RING_ISCH). After ring release, another dataset was acquired before (No_Ring_BL) and after left circumflex artery occlusion (No_Ring_ISCH). Anterior and posterior mitral leaflet tenting areas were computed at mid-systole from sums of marker triangles with the midpoint between the annular markers being the vertex for all triangles.

Results

Compared with No_Ring_BL, mitral regurgitation grades and all tenting areas significantly increased with No_Ring_ISCH. Compared with No_Ring_ISCH, (1) all rings significantly prevented mitral regurgitation and reduced all tenting areas; (2) Edwards IMR ETLogix and GeoForm rings reduced posterior mitral leaflet area, but not anterior mitral leaflet tenting area, to a significantly greater extent than the Carpentier-Edwards Physio ring; and (3) Edwards IMR ETLogix and GeoForm rings affected tenting areas similarly.

Conclusions

In response to acute left ventricular ischemia, disease-specific functional/ischemic mitral regurgitation rings (Edwards IMR ETLogix, GeoForm) more effectively reduced posterior mitral leaflet area, but not anterior mitral leaflet tenting area, compared with true-sized physiologic rings (Carpentier-Edwards Physio). Despite its radical 3-dimensional shape and greater amount of mitral annular septal-lateral downsizing, the GeoForm ring did not reduce tenting areas more than the Edwards IMR ETLogix ring, suggesting that further reduction in tenting areas in patients with FMR/IMR may not be effectively achieved on an annular level.

Place, publisher, year, edition, pages
Elsevier, 2011. Vol. 141, no 2, 345-353 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-76223DOI: 10.1016/j.jtcvs.2010.10.015PubMedID: 21241857OAI: oai:DiVA.org:liu-76223DiVA: diva2:513041
Available from: 2012-03-30 Created: 2012-03-30 Last updated: 2017-12-07

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Kvitting, John-Peder Escobar

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