BACKGROUND: Saddle-shaped annuloplasty rings are being increasingly used during mitral valve (MV) repair to conform the mitral annulus to a more nonplanar shape and possibly reduce leaflet stress. In this study utilizing three-dimensional transesophageal echocardiography we compared the effects of rigid flat rings with those of the saddle rings on the mitral annular geometry. Specifically we measured the changes in nonplanarity angle (NPA) before and after MV repair. METHODS: Geometric analysis on 38 patients undergoing MV repair for myxomatous and ischemic mitral regurgitation with full flat rings (n = 18) and saddle rings (n = 18) were performed. The acquired three-dimensional volumetric data were analyzed utilizing the "Image Arena" software (TomTec GmBH, Munich, Germany). Specifically, the degree of change in the NPA was calculated and compared before and after repair for both types of rings. RESULTS: Both types of annuloplasty rings resulted in significant changes in the geometric structure of the MV after repair. However, saddle rings lead to a decrease in the NPA (7% for ischemic and 8% for myxomatous MV repairs) (ie, made the annulus more nonplanar), whereas flat rings increased the NPA (7.9% for ischemic and 11.8% for myxomatous MV repairs) (ie, made the annulus less nonplanar); p value 0.001 or less. CONCLUSIONS: Implantation of saddle-shaped rings during MV repair surgery is associated with augmentation of the nonplanar shape of the mitral annulus (ie, decreases NPA). This favorable change in the mitral annular geometry could possibly confer a structural advantage to MV repairs with the saddle rings.
BACKGROUND: Saddle-shaped annuloplasty rings are being increasingly used during mitral valve (MV) repair to conform the mitral annulus to a more nonplanar shape and possibly reduce leaflet stress. In this study utilizing three-dimensional transesophageal echocardiography we compared the effects of rigid flat rings with those of the saddle rings on the mitral annular geometry. Specifically we measured the changes in nonplanarity angle (NPA) before and after MV repair. METHODS: Geometric analysis on 38 patients undergoing MV repair for myxomatous and ischemic mitral regurgitation with full flat rings (n = 18) and saddle rings (n = 18) were performed. The acquired three-dimensional volumetric data were analyzed utilizing the "Image Arena" software (TomTec GmBH, Munich, Germany). Specifically, the degree of change in the NPA was calculated and compared before and after repair for both types of rings. RESULTS: Both types of annuloplasty rings resulted in significant changes in the geometric structure of the MV after repair. However, saddle rings lead to a decrease in the NPA (7% for ischemic and 8% for myxomatous MV repairs) (ie, made the annulus more nonplanar), whereas flat rings increased the NPA (7.9% for ischemic and 11.8% for myxomatous MV repairs) (ie, made the annulus less nonplanar); p value 0.001 or less. CONCLUSIONS: Implantation of saddle-shaped rings during MV repair surgery is associated with augmentation of the nonplanar shape of the mitral annulus (ie, decreases NPA). This favorable change in the mitral annular geometry could possibly confer a structural advantage to MV repairs with the saddle rings.
Authors: Joseph H Gorman; Robert C Gorman; Benjamin M Jackson; Yoshiharu Enomoto; Martin G St John-Sutton; L Henry Edmunds Journal: Ann Thorac Surg Date: 2003-11 Impact factor: 4.330
Authors: Tomasz A Timek; David T Lai; David Liang; Fredrick Tibayan; Frank Langer; Filiberto Rodriguez; George T Daughters; Neil B Ingels; D Craig Miller Journal: Circulation Date: 2004-09-14 Impact factor: 29.690
Authors: Jun Kwan; Jian Xin Qin; Zoran B Popović; Deborah A Agler; James D Thomas; Takahiro Shiota Journal: J Am Soc Echocardiogr Date: 2004-11 Impact factor: 5.251
Authors: A M Gillinov; D M Cosgrove; T Shiota; J Qin; H Tsujino; W J Stewart; J D Thomas; M Porqueddu; J A White; E H Blackstone Journal: Ann Thorac Surg Date: 2000-03 Impact factor: 4.330
Authors: Ivan S Salgo; Joseph H Gorman; Robert C Gorman; Benjamin M Jackson; Frank W Bowen; Theodore Plappert; Martin G St John Sutton; L Henry Edmunds Journal: Circulation Date: 2002-08-06 Impact factor: 29.690
Authors: John R Liddicoat; Briain D Mac Neill; A Marc Gillinov; William E Cohn; Chi-Hui Chin; Aldo D Prado; Natesa G Pandian; Stephen N Oesterle Journal: Catheter Cardiovasc Interv Date: 2003-11 Impact factor: 2.692
Authors: Frederick A Tibayan; Filiberto Rodriguez; Frank Langer; Mary K Zasio; Lynn Bailey; David Liang; George T Daughters; Neil B Ingels; D Craig Miller Journal: Ann Thorac Surg Date: 2003-11 Impact factor: 4.330
Authors: B Graser; D Wald; S Al-Maisary; M Grossgasteiger; R de Simone; H-P Meinzer; I Wolf Journal: Int J Comput Assist Radiol Surg Date: 2014-07 Impact factor: 2.924
Authors: Matthew A Jolley; Peter E Hammer; Sunil J Ghelani; Adi Adar; Lynn A Sleeper; Ronald V Lacro; Gerald R Marx; Meena Nathan; David M Harrild Journal: J Am Soc Echocardiogr Date: 2018-08-08 Impact factor: 5.251
Authors: Wobbe Bouma; Chikashi Aoki; Mathieu Vergnat; Alison M Pouch; Shanna R Sprinkle; Matthew J Gillespie; Massimo A Mariani; Benjamin M Jackson; Robert C Gorman; Joseph H Gorman Journal: Ann Thorac Surg Date: 2015-07-14 Impact factor: 4.330
Authors: Chung-Hao Lee; Jean-Pierre Rabbah; Ajit P Yoganathan; Robert C Gorman; Joseph H Gorman; Michael S Sacks Journal: Biomech Model Mechanobiol Date: 2015-05-07