Wobbe Bouma1, Chikashi Aoki2, Mathieu Vergnat2, Alison M Pouch2, Shanna R Sprinkle2, Matthew J Gillespie2, Massimo A Mariani3, Benjamin M Jackson2, Robert C Gorman2, Joseph H Gorman4. 1. Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania; University of Groningen, University Medical Center Groningen, Department of Cardiothoracic Surgery, Groningen, Netherlands. 2. Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania. 3. University of Groningen, University Medical Center Groningen, Department of Cardiothoracic Surgery, Groningen, Netherlands. 4. Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: gormanj@uphs.upenn.edu.
Abstract
BACKGROUND: Current repair results for ischemic mitral regurgitation (IMR) with undersized annuloplasty rings are characterized by high IMR recurrence rates. Current annuloplasty rings treat annular dilatation, but they do little to improve (and may actually exacerbate) leaflet tethering. New saddle-shaped annuloplasty rings have been shown to maintain or restore a more physiologic annular and leaflet geometry and function. Using a porcine IMR model, we sought to demonstrate the influence of annuloplasty ring shape on leaflet coaptation. METHODS: Eight weeks after posterolateral infarct, eight pigs with grade 2+ or higher IMR were randomized to undergo either a 28-mm flat ring annuloplasty (n = 4) or a 28-mm saddle-shaped ring annuloplasty (n = 4). Real-time three-dimensional echocardiography and a customized image analysis protocol allowed three-dimensional assessment of leaflet coaptation before and after annuloplasty. RESULTS: Total leaflet coaptation area was significantly higher after saddle-shaped ring annuloplasty (109.6 ± 26.9 mm(2)) compared with flat ring annuloplasty (46.2 ± 7.7 mm(2), p <0.01). After annuloplasty, total coaptation area decreased by 87.5 mm(2) (or 65%) in the flat annuloplasty group (p = 0.01), whereas total coaptation area increased by 22.2 mm(2) (or 25%) in the saddle-shaped annuloplasty group (p = 0.28). CONCLUSIONS: This study shows that the use of undersized saddle-shaped annuloplasty rings in mitral valve repair for IMR improves leaflet coaptation, whereas the use of undersized flat annuloplasty rings worsens leaflet coaptation. Because one of Carpentier's fundamental principles of mitral valve repair (durability) is to create a large surface of coaptation, saddle-shaped annuloplasty may increase repair durability.
BACKGROUND: Current repair results for ischemic mitral regurgitation (IMR) with undersized annuloplasty rings are characterized by high IMR recurrence rates. Current annuloplasty rings treat annular dilatation, but they do little to improve (and may actually exacerbate) leaflet tethering. New saddle-shaped annuloplasty rings have been shown to maintain or restore a more physiologic annular and leaflet geometry and function. Using a porcine IMR model, we sought to demonstrate the influence of annuloplasty ring shape on leaflet coaptation. METHODS: Eight weeks after posterolateral infarct, eight pigs with grade 2+ or higher IMR were randomized to undergo either a 28-mm flat ring annuloplasty (n = 4) or a 28-mm saddle-shaped ring annuloplasty (n = 4). Real-time three-dimensional echocardiography and a customized image analysis protocol allowed three-dimensional assessment of leaflet coaptation before and after annuloplasty. RESULTS: Total leaflet coaptation area was significantly higher after saddle-shaped ring annuloplasty (109.6 ± 26.9 mm(2)) compared with flat ring annuloplasty (46.2 ± 7.7 mm(2), p <0.01). After annuloplasty, total coaptation area decreased by 87.5 mm(2) (or 65%) in the flat annuloplasty group (p = 0.01), whereas total coaptation area increased by 22.2 mm(2) (or 25%) in the saddle-shaped annuloplasty group (p = 0.28). CONCLUSIONS: This study shows that the use of undersized saddle-shaped annuloplasty rings in mitral valve repair for IMR improves leaflet coaptation, whereas the use of undersized flat annuloplasty rings worsens leaflet coaptation. Because one of Carpentier's fundamental principles of mitral valve repair (durability) is to create a large surface of coaptation, saddle-shaped annuloplasty may increase repair durability.
Authors: Liam P Ryan; Benjamin M Jackson; Yoshiharu Enomoto; Landi Parish; Theodore J Plappert; Martin G St John-Sutton; Robert C Gorman; Joseph H Gorman Journal: J Thorac Cardiovasc Surg Date: 2007-09 Impact factor: 5.209
Authors: Walter R T Witschey; James J Pilla; Giovanni Ferrari; Kevin Koomalsingh; Mohammed Haris; Robin Hinmon; Gerald Zsido; Joseph H Gorman; Robert C Gorman; Ravinder Reddy Journal: Magn Reson Med Date: 2010-11 Impact factor: 4.668
Authors: Morten O Jensen; Henrik Jensen; Robert A Levine; Ajit P Yoganathan; Niels Trolle Andersen; Hans Nygaard; J Michael Hasenkam; Sten L Nielsen Journal: J Thorac Cardiovasc Surg Date: 2011-02-16 Impact factor: 5.209
Authors: J H Gorman; K B Gupta; J T Streicher; R C Gorman; B M Jackson; M B Ratcliffe; D K Bogen; L H Edmunds Journal: J Thorac Cardiovasc Surg Date: 1996-09 Impact factor: 5.209
Authors: Benjamin H Trichon; G Michael Felker; Linda K Shaw; Christopher H Cabell; Christopher M O'Connor Journal: Am J Cardiol Date: 2003-03-01 Impact factor: 2.778
Authors: Edwin C McGee; A Marc Gillinov; Eugene H Blackstone; Jeevanantham Rajeswaran; Gideon Cohen; Farzad Najam; Takahiro Shiota; Joseph F Sabik; Bruce W Lytle; Patrick M McCarthy; Delos M Cosgrove Journal: J Thorac Cardiovasc Surg Date: 2004-12 Impact factor: 5.209
Authors: Feroze Mahmood; Balachundhar Subramaniam; Joseph H Gorman; Robert M Levine; Robert C Gorman; Andrew Maslow; Peter J Panzica; Robert M Hagberg; Swaminathan Karthik; Kamal R Khabbaz Journal: Ann Thorac Surg Date: 2009-12 Impact factor: 4.330
Authors: Wobbe Bouma; Iwan C C van der Horst; Inez J Wijdh-den Hamer; Michiel E Erasmus; Felix Zijlstra; Massimo A Mariani; Tjark Ebels Journal: Eur J Cardiothorac Surg Date: 2009-08-27 Impact factor: 4.191
Authors: Judy Hung; Lampros Papakostas; Stephen A Tahta; Bruce G Hardy; Bruce A Bollen; Carlos M Duran; Robert A Levine Journal: Circulation Date: 2004-09-14 Impact factor: 29.690
Authors: Beatrice E Ncho; Eric L Pierce; Charles H Bloodworth; Akito Imai; Keitaro Okamoto; Yoshiaki Saito; Robert C Gorman; Joseph H Gorman; Ajit P Yoganathan Journal: J Thorac Cardiovasc Surg Date: 2019-05-31 Impact factor: 5.209
Authors: Annabel M Imbrie-Moore; Yuanjia Zhu; Tabitha Bandy-Vizcaino; Matthew H Park; Robert J Wilkerson; Y Joseph Woo Journal: Ann Biomed Eng Date: 2021-11-03 Impact factor: 4.219
Authors: Philip Y K Pang; Ming Jie Huang; Teing Ee Tan; See Lim Lim; Madhava J Naik; Victor T T Chao; Yoong Kong Sin; Chong Hee Lim; Yeow Leng Chua Journal: J Thorac Dis Date: 2019-12 Impact factor: 2.895