Article

How much septal-lateral mitral annular reduction do you get with new ischemic/functional mitral regurgitation annuloplasty rings?

Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif. 94305-5247, USA.
The Journal of thoracic and cardiovascular surgery (impact factor: 3.41). 07/2010; 140(1):117-21, 121.e1-3. DOI:10.1016/j.jtcvs.2009.10.033 pp.117-21, 121.e1-3
Source: PubMed

ABSTRACT Disproportionate reduction of the mitral septal-lateral annular dimension is the goal in the surgical treatment of ischemic or functional mitral regurgitation and avoids the need for ring "downsizing." How much the new annuloplasty rings designed for patients with ischemic/functional mitral regurgitation reduce annular septal-lateral dimension, however, is proprietary information and debated.
Outer and inner septal-lateral and commissure-commissure diameters of all available sizes of Edwards GeoForm, Edwards IMR ETlogix (both Edwards Lifesciences, Irvine, Calif), St Jude Medical Rigid Saddle Annuloplasty Ring (St Jude Medical, Inc, St Paul, Minn), and Medtronic Profile 3D (Medtronic, Minneapolis, Minn) annuloplasty rings with and without the fabric covering were measured with electronic calipers. These rings were compared with a Carpentier-Edwards Physio ring (Edwards Lifesciences) to assess the relative amount of septal-lateral and commissure-commissure dimension change. Average fractional changes (% +/-1 standard deviation) versus the Physio ring were calculated.
The GeoForm provided the greatest outer septal-lateral reduction relative to Physio ring (-24% +/- 2%), followed by the IMR ETlogix (-9% +/- 2%) and Profile 3D (-8% +/- 5%). The septal-lateral diameter of the Rigid Saddle Annuloplasty Ring was similar to that of the Physio ring (+1% +/- 3%). Although commissure-commissure outer diameters of the IMR ETlogix, Rigid Saddle Annuloplasty Ring, and Profile 3D were similar to that of the Physio ring (0% +/- 2%, +4% +/- 3%, and +3% +/- 4%, respectively), the GeoForm had a larger commissure-commissure dimension (+12% +/- 2%). The inner diameter septal-lateral reductions were even more pronounced.
Relative to the Physio ring, the GeoForm has the most outer and inner septal-lateral reduction but larger commissure-commissure dimension; the IMR ETlogix and Profile 3D provide a moderate degree of septal-lateral reduction without affecting commissure-commissure dimension, and Rigid Saddle Annuloplasty Ring septal-lateral and commissure-commissure diameters are similar to those of the Physio ring. Knowing the degree of disproportionate septal-lateral downsizing inherent in each ring type will help guide surgical decision making.

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    Article: Mechanics of healthy and functionally diseased mitral valves: a critical review.
    Jean-Pierre M Rabbah, Neelakantan Saikrishnan, Andrew W Siefert, Arvind Santhanakrishnan, Ajit P Yoganathan
    [show abstract] [hide abstract]
    ABSTRACT: The mitral valve is a complex apparatus with multiple constituents that work cohesively to ensure unidirectional flow between the left atrium and ventricle. Disruption to any or all of the components-the annulus, leaflets, chordae, and papillary muscles-can lead to backflow of blood, or regurgitation, into the left atrium, which deleteriously effects patient health. Through the years, a myriad of surgical repairs have been proposed; however, a careful appreciation for the underlying structural mechanics can help optimize long-term repair durability and inform medical device design. In this review, we aim to present the experimental methods and significant results that have shaped the current understanding of mitral valve mechanics. Data will be presented for all components of the mitral valve apparatus in control, pathological, and repaired conditions from human, animal, and in vitro studies. Finally, current strategies of patient specific and noninvasive surgical planning will be critically outlined.
    Journal of Biomechanical Engineering 02/2013; 135(2):021007. · 1.90 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

annular septal-lateral dimension
 
Carpentier-Edwards Physio ring
 
Disproportionate reduction
 
functional mitral regurgitation
 
greatest outer septal-lateral reduction
 
inner diameter septal-lateral reductions
 
inner septal-lateral
 
inner septal-lateral reduction
 
ischemic/functional mitral regurgitation
 
larger commissure-commissure dimension
 
Medtronic Profile 3D
 
mitral septal-lateral annular dimension
 
new annuloplasty rings
 
Physio ring
 
Profile 3D
 
Rigid Saddle Annuloplasty Ring
 
Rigid Saddle Annuloplasty Ring septal-lateral
 
ring type
 
septal-lateral reduction
 
St Jude Medical Rigid Saddle Annuloplasty Ring
 

Wolfgang Bothe