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van Kampen A, Morningstar JE, Goudot G, Ingels N, Wenk JF, Nagata Y, Yaghoubian KM, Norris RA, Borger MA, Melnitchouk S, Levine RA, Jensen MO. Utilization of Engineering Advances for Detailed Biomechanical Characterization of the Mitral-Ventricular Relationship to Optimize Repair Strategies: A Comprehensive Review. Bioengineering (Basel) 2023; 10:601. [PMID: 37237671 PMCID: PMC10215167 DOI: 10.3390/bioengineering10050601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
The geometrical details and biomechanical relationships of the mitral valve-left ventricular apparatus are very complex and have posed as an area of research interest for decades. These characteristics play a major role in identifying and perfecting the optimal approaches to treat diseases of this system when the restoration of biomechanical and mechano-biological conditions becomes the main target. Over the years, engineering approaches have helped to revolutionize the field in this regard. Furthermore, advanced modelling modalities have contributed greatly to the development of novel devices and less invasive strategies. This article provides an overview and narrative of the evolution of mitral valve therapy with special focus on two diseases frequently encountered by cardiac surgeons and interventional cardiologists: ischemic and degenerative mitral regurgitation.
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Affiliation(s)
- Antonia van Kampen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Leipzig Heart Centre, University Clinic of Cardiac Surgery, 02189 Leipzig, Germany
| | - Jordan E. Morningstar
- Department of Regenerative Medicine and Cell Biology, University of South Carolina, Charleston, SC 29425, USA
| | - Guillaume Goudot
- Cardiac Ultrasound Laboratory, Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Neil Ingels
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA
| | - Jonathan F. Wenk
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY 40508, USA;
| | - Yasufumi Nagata
- Cardiac Ultrasound Laboratory, Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Koushiar M. Yaghoubian
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell Biology, University of South Carolina, Charleston, SC 29425, USA
| | - Michael A. Borger
- Leipzig Heart Centre, University Clinic of Cardiac Surgery, 02189 Leipzig, Germany
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Robert A. Levine
- Cardiac Ultrasound Laboratory, Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Morten O. Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Sidiki AI, Akulova AA, Hussein MH, Al-Ariki MK, Donsov VV, Iluhin MA, Limeshkin AA, Ananko VA. Physio and Physio II rings: beyond the annular physiology. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:529-535. [PMID: 35848871 DOI: 10.23736/s0021-9509.22.11874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Engineering of the Carpentier-Edwards Physio (PR-I) and Physio II (PR-II) rings (Edwards Lifesciences Corp., Irvine, CA, USA) combines flexibility with remodeling. PR-II is considered an improvement of PR-I, as it boasts of an improved shape, a double saddle, and a sewing cuff that reduces tension on sutures. Beyond the superior effect of the PR-II on the annular physiology, it has not been proven to be clinically better than the PR-I. This study compares the long-term clinical outcomes of MV repair for degenerative disease with these rings. METHODS From 2004 to 2020, MV repair with Physio ring annuloplasty (group PR-I) was performed in 231 patients, and with Physio-II ring annuloplasty (group PR-II) in 255 patients. A propensity score-matching analysis was used to pair 104 in each group. Primary outcome was recurrent MR≥3 and secondary outcomes were long-term survival, cardiac death, and MV-related events (MVREs). The 15-year follow-up data were complete in 97.3% of patients. RESULTS There were no differences in 15-year freedom from recurrent MR (P=0.721), survival and cardiac death between the matched groups (P=0.693 and P=0.135, respectively). MVREs, including cardiac death, pacemaker implantation, thromboembolism, bleeding, and reoperation were also similar between the matched groups (P=0.603). However, 5-year recurrent MR was significantly higher in PR-I than in PR-II (P=0.010). Multivariate analysis showed Barlow's disease and preoperative MR≥3 as risk factors for late MR recurrence. CONCLUSIONS Type of annuloplasty rings did not influence long-term clinical outcomes. Better annular dynamics seen in PR-II annuloplasty does not translate into superior freedom from recurrent MR.
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Affiliation(s)
- Abubakari I Sidiki
- Department of Cardiothoracic Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia -
| | - Anastasia A Akulova
- Department of Cardiothoracic Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia
| | - Marina H Hussein
- Department of Cardiothoracic Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia
| | - Malik K Al-Ariki
- Department of Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia
| | - Vladislav V Donsov
- Department of Cardiac Surgery, M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - Mikhail A Iluhin
- Cardiovascular Center, FSBI 3 Central Vishnevsky Hospital, Moscow, Russia
| | - Andrei A Limeshkin
- Cardiovascular Center, FSBI 3 Central Vishnevsky Hospital, Moscow, Russia
| | - Vadim A Ananko
- Cardiovascular Center, FSBI 3 Central Vishnevsky Hospital, Moscow, Russia
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Secondary Mitral Regurgitation Repair Techniques and Outcomes: Initial Clinical Experience with Mitral Valve Translocation. JTCVS Tech 2022; 13:53-57. [PMID: 35711194 PMCID: PMC9196134 DOI: 10.1016/j.xjtc.2022.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
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Jedrzejczyk JH, Carlson Hanse L, Javadian S, Skov SN, Hasenkam JM, Thørnild MJ. Mitral Annular Forces and Their Potential Impact on Annuloplasty Ring Selection. Front Cardiovasc Med 2022; 8:799994. [PMID: 35059450 PMCID: PMC8765723 DOI: 10.3389/fcvm.2021.799994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/10/2021] [Indexed: 01/01/2023] Open
Abstract
Objectives: To provide an overview that describes the characteristics of a mitral annuloplasty device when treating patients with a specific type of mitral regurgitation according to Carpentier's classification of mitral regurgitation.Methods: Starting with the key search term “mitral valve annuloplasty,” a literature search was performed utilising PubMed, Google Scholar, and Web of Science to identify relevant studies. A systematic approach was used to assess all publications.Results: Mitral annuloplasty rings are traditionally categorised by their mechanical compliance in rigid-, semi-rigid-, and flexible rings. There is a direct correlation between remodelling capabilities and rigidity. Thus, a rigid annuloplasty ring will have the highest remodelling capability, while a flexible ring will have the lowest. Rigid- and semi-rigid rings can furthermore be divided into flat and saddled-shaped rings. Saddle-shaped rings are generally preferred over flat rings since they decrease annular and leaflet stress accumulation and provide superior leaflet coaptation. Finally, mitral annuloplasty rings can either be complete or partial.Conclusions: A downsized rigid- or semi-rigid ring is advantageous when higher remodelling capabilities are required to correct dilation of the mitral annulus, as seen in type I, type IIIa, and type IIIb mitral regurgitation. In type II mitral regurgitation, a normosized flexible ring might be sufficient and allow for a more physiological repair since there is no annular dilatation, which diminishes the need for remodelling capabilities. However, mitral annuloplasty ring selection should always be based on the specific morphology in each patient.
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Affiliation(s)
- Johannes H. Jedrzejczyk
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- *Correspondence: Johannes H. Jedrzejczyk
| | - Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Shadi Javadian
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren N. Skov
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J. Michael Hasenkam
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Marcell J. Thørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Zhan-Moodie S, Xu D, Suresh KS, He Q, Onohara D, Kalra K, Guyton RA, Sarin EL, Padala M. Papillary muscle approximation reduces systolic tethering forces and improves mitral valve closure in the repair of functional mitral regurgitation. JTCVS OPEN 2021; 7:91-104. [PMID: 35299626 PMCID: PMC8924981 DOI: 10.1016/j.xjon.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Undersizing mitral annuloplasty (UMA) to repair functional mitral regurgitation (FMR) lacks durability, as it forces leaflet coaptation without relieving the subleaflet tethering forces. In this biomechanical study, we demonstrate that papillary muscle approximation (PMA) before UMA can drastically relieve tethering forces and improve valve function, without the need for significant annular downsizing. Methods An ex vivo model of FMR was used, in which pig mitral valves were geometrically perturbed to induce FMR, and the repairs were performed. Nine pig mitral valves were studied in the following sequence: normal (baseline), FMR, true-sized annuloplasty to 30 mm (true-sized ring [TSR]), and undersized annuloplasty to 26 mm (down-sized ring [DSR]), along with concomitant PMA at both ring sizes. Mitral regurgitation, valve kinematics, and chordal forces were measured and compared among the groups. Results FMR geometry induced a mean regurgitant fraction of 16.31 ± 7.33% compared with 0% at baseline. TSR reduced the regurgitant fraction to 6.05 ± 5.63%, whereas DSR reduced it to 5.06 ± 6.76%. The addition of PMA before the use of these rings reduced the mean regurgitant fraction to 3.87 ± 6.79% with the TSR (TSR + PMA) and 3.71 ± 6.25% with the DSR (DSR + PMA). Mean peak anterior and posterior marginal chordal forces were elevated to 0.09 ± 0.1 N and 0.12 ± 0.1 N, respectively, with FMR and were not reduced by annuloplasty of either sizes. The addition of PMA significantly reduced these forces to 0.23 ± 0.02 N and 0.51 ± 0.04 N. Conclusions This biomechanical study demonstrates that PMA relieves tethering forces, and concomitantly with annuloplasty it mobilizes the leaflets to achieve physiological valve closure. Such a result could be achieved without the need for extensive annular downsizing.
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Misumi Y, Kainuma S, Toda K, Miyagawa S, Yoshioka D, Hirayama A, Kitamura T, Komukai S, Sawa Y. Left ventricle-mitral valve ring size mismatch following ring annuloplasty for nonischemic dilated cardiomyopathy. J Thorac Cardiovasc Surg 2021; 165:2026-2033. [PMID: 34246489 DOI: 10.1016/j.jtcvs.2021.05.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In patients with ischemic mitral regurgitation (MR) undergoing restrictive mitral annuloplasty (RMA), the ratio of left ventricular (LV) end-systolic dimension (LVESD) to mitral valve (MV) ring size (ie, LV-MV ring mismatch) is associated with postoperative recurrent MR. However, the impact of LV-MV ring mismatch on postoperative recurrent MR, LV function recovery, and long-term survival in patients with nonischemic dilated cardiomyopathy (DCM) remains unknown. METHODS Sixty-six patients with nonischemic DCM (mean LVESD, 62 mm) underwent RMA (mean ring size, 26 mm) between 2003 and 2014. Recurrent MR was defined as MR grade ≥2+ at a 6-month echocardiographic evaluation. RESULTS At the 6-month follow-up, 23 patients (35%) had developed recurrent MR. In univariable logistic regression analysis, larger LVESD (P = .012) and LVESD/ring size ratio (P = .008) were associated with recurrent MR. In multivariable models adjusted for age, sex, baseline LV ejection fraction, and severe MR, only LVESD/ring size ratio (odds ratio, 4.65; 95% confidence interval, 1.04-25.0; P = .048) remained significantly associated with MR recurrence. Receiver operating characteristic curve analysis demonstrated an optimal cutoff value for the LVESD/ring size ratio of 2.42. Patients with an LVESD/ring size ratio >2.42 (n = 30; mismatch) had a lower 5-year cumulative survival rate compared with those with an LVESD/ring size ratio ≤2.42 (n = 36; nonmismatch) (52% vs 71%; P = .045). Postoperatively, LV dimensions were significantly reduced in both groups; however, improvements in LVEF were only modest in the mismatched group (P = .091). CONCLUSIONS LV-MV ring size mismatch was associated with an increased risk of recurrent MR in our series. This finding may aid the formulation of surgical strategies for patients with nonischemic DCM.
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Affiliation(s)
- Yusuke Misumi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Hirayama
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Sho Komukai
- Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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Scorsin M, Andreas M, Corona S, Guta AC, Aruta P, Badano LP. Novel transcatheter mitral prosthesis designed to preserve physiological ventricular flow dynamics. Ann Thorac Surg 2021; 113:593-599. [PMID: 33838122 DOI: 10.1016/j.athoracsur.2021.03.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current mitral bioprostheses are akin to the aortic valve and therefore abolish the left ventricular (LV) physiological vortex. We evaluated the hemodynamic performance and the effects on intraventricular flow dynamics (IFD) of a novel mitral bioprosthesis that presents an innovative design, mimicking the native valve. METHODS A D-shaped self-expandable stent-bovine pericardium monoleaflet valve was designed to provide physiological asymmetric intraventricular flow. Twelve juvenile sheep were consecutively implanted transapically. Post-implant studies were obtained immediately after the implantation and at 3 months to assess the hemodynamic performance of the prostheses, using Doppler echocardiography and IFD using echo particle imaging velocimetry. RESULTS Three deaths occurred during follow-up, one due to valve misplacement because of poor imaging visualization and 2 not valve related. Mean transvalvular gradient and effective orifice area after implantation and at 3 months were 2.2 ± 1.2 mmHg and 4.0 ± 1.1 cm2, and 3.3 ± 1.5 mmHg and 3.5 ± 0.5 cm2, respectively. LV vortex dimension, orientation and physiologic anti-clockwise rotation were preserved compared with pre-operative normal LV flow pattern. One animal showed a moderate paravalvular leak, others mild or none. LV outflow tract obstruction, valve thrombosis or hemolysis were not observed. CONCLUSIONS Our preclinical in vivo results, confirm the good hemodynamic performance of this new transcatheter bioprosthesis with preservation of the physiological IFD. Clinical studies are needed to document whether these characteristics will foster LV recovery and improve the clinical outcome of patients with mitral regurgitation.
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Affiliation(s)
- Marcio Scorsin
- Jilin Heart Hospital, Department of Cardiac Surgery, Changchun, China.
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Silvia Corona
- Department of Cardiac Surgery, Centro Cardiologico Monzino, University of Milan, Milan Italy
| | - Andrada Camelia Guta
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Patrizia Aruta
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Luigi Paolo Badano
- Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of medicine and surgery, University of Milano-Bicocca, Milan, Italy
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Hata M, Fujita B, Hakim-Meibodi K, Gummert JF. Papillary Muscle Heads Focalization for Functional Mitral Valve Regurgitation. Ann Thorac Surg 2020; 110:e59-e61. [PMID: 32199828 DOI: 10.1016/j.athoracsur.2020.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/24/2020] [Accepted: 02/06/2020] [Indexed: 11/25/2022]
Abstract
Mitral valve annuloplasty has been the gold standard for treatment of functional mitral valve regurgitation. However, annuloplasty for functional mitral regurgitation may cause augmented posterior leaflet tethering, which results in functional anterior prolapse. Herein we added papillary muscle heads focalization for such patients. All separated papillary muscle heads are sutured together, and the roots of chordae at each papillary muscle are unifocalized on both sides. Stitches are positioned at the same distances from corresponding leaflet edges to adjust the height of leaflet edges in each segment. This is a simple and effective technique to correct for functional anterior prolapse after annuloplasty.
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Affiliation(s)
- Masatoshi Hata
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany.
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck, Germany
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
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Timek TA. Commentary: May the force be with you. J Thorac Cardiovasc Surg 2020; 159:e185-e186. [PMID: 31926714 DOI: 10.1016/j.jtcvs.2019.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Mich.
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Yokote J, Araki Y, Saito S, Hasegawa H, Usui A. Effect of an artificial ring on mitral valve function. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:207-215. [PMID: 31239589 PMCID: PMC6556447 DOI: 10.18999/nagjms.81.2.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Differences of the effect of annuloplasty rings on the mitral annulus and leaflets, and differences between types of annuloplasty rings are not well known. We analyzed annular motion and leaflet movement with a rigid or flexible ring and without a ring using an isolated swine working heart model. Hearts of 10 swine (weight: 40–50 kg) were used for a rigid ring (n=5) and a flexible ring (n=5). Four ultrasound crystal tips were fixed around the annulus and an annuloplasty ring was implanted in the isolated heart. In the working heart mode, measurement of mitral annular dimension was acquired by sonomicrometry. Images of mitral valve motion were acquired by a high-speed video camera. The same analyses were performed after removing the artificial ring. The antero-posterior diameter of the diastole distance was significantly reduced in the flexible ring (21.59±0.71 mm) and rigid ring (15.93±1.88 mm) compared with no ring (23.51±2.01 mm). The flexible ring made the transverse diameter shrink significantly more than did the rigid ring. The contraction range of the transverse diameter was significantly smaller in the flexible ring compared with no ring. The duration of opening to closing of the mitral leaflet with the rigid (124.7±4.4 ms) and flexible rings (107.9±3.5 ms) was significantly shorter than that with no ring (168±36.5 ms). Annuloplasty rings allow simplicity of leaflet motion, regardless of the type of artificial ring. In a flexible ring, the mitral annulus shows a vertically long shape, suggesting preservation of posterior annular movement.
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Affiliation(s)
- Jun Yokote
- Department of Cardiovascular Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yoshimori Araki
- Department of Cardiac Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Shunei Saito
- Department of Cardiovascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Hiroki Hasegawa
- Department of Cardiovascular Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Gasior T, Gavazzoni M, Taramasso M, Zuber M, Maisano F. Direct Percutaneous Mitral Annuloplasty in Patients With Functional Mitral Regurgitation: When and How. Front Cardiovasc Med 2019; 6:152. [PMID: 31788478 PMCID: PMC6855240 DOI: 10.3389/fcvm.2019.00152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/07/2019] [Indexed: 11/13/2022] Open
Abstract
Mitral regurgitation (MR) is a frequent valvular disease among patients deemed too high risk for surgery. Echocardiography along with CT is the primary diagnostic tool for MR and offers a comprehensive 3D assessment in patient selection and screening for the optimal treatment method. The direct percutaneous mitral annuloplasty addresses the underlying mechanisms of functional MR with a less invasive, catheter-based approach. The here-described techniques proved a sufficient safety profile, delivered significant MR reduction in most of the cases, and were associated with a notable improvement of symptoms. Although long-term outcome assessment is needed to support these early reports, the percutaneous mitral annuloplasty is likely to set a new standard of treatment in the forthcoming future.
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Affiliation(s)
- Tomasz Gasior
- University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mara Gavazzoni
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Taramasso
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michel Zuber
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Mitral Valve and Subvalvular Repair for Secondary Mitral Regurgitation: Rationale and Clinical Outcomes of the Papillary Muscle Sling. Cardiol Rev 2018; 26:22-28. [PMID: 29206746 DOI: 10.1097/crd.0000000000000168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Secondary mitral regurgitation (MR) is a common finding in patients with dilated cardiomyopathy, and it is associated with poor outcomes. It is the result of incomplete systolic closure of the mitral valve (MV) as a consequence of left ventricular dilatation, papillary muscle displacement with impaired systolic shortening, and mitral leaflet tethering. MV surgery may be performed in cases of significant secondary MR despite guideline-directed medical therapy. However, MV repair, which is most commonly performed with an undersized ring annuloplasty, is associated with a 30-60% recurrence of moderate or greater MR at mid-term follow-up. To improve MV repair durability, several adjunctive subvalvular procedures have been proposed, one of which is the addition of papillary muscle approximation utilizing a papillary muscle sling. Recent studies comparing the outcomes of a conventional undersized ring annuloplasty with a MV repair utilizing a papillary muscle sling have reported a significant reduction in recurrent moderate or severe MR, greater left ventricular reverse remodeling, and improved MV apparatus geometry with the addition of the papillary muscle sling. We present a comprehensive review of the pathophysiology of secondary MR, and the rationale and clinical outcomes of MV repair with papillary muscle sling placement for the treatment of secondary MR.
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Kainuma S, Funatsu T, Kondoh H, Yokota T, Maeda S, Shudo Y, Matsue H, Nishino M, Daimon T, Toda K, Sawa Y, Taniguchi K. Beneficial effects of restrictive annuloplasty on subvalvular geometry in patients with functional mitral regurgitation and advanced cardiomyopathy. J Thorac Cardiovasc Surg 2017; 156:630-638.e1. [PMID: 29395191 DOI: 10.1016/j.jtcvs.2017.11.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/15/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The effects of restrictive mitral annuloplasty (RMA) on subvalvular geometry remains unknown. We evaluated changes in left ventricular (LV) function, severity of mitral regurgitation (MR), and leaflet tethering parameters after RMA and clarified their associations. METHODS In 44 patients with clinically relevant functional MR who underwent RMA, distances between papillary muscle (PM) tips and anterior mitral annulus (PM tethering distance), leaflet angles relative to lines connecting annuli, and interpapillary muscle distance (IPMD) were serially quantified. RESULTS One month after surgery, LV function and MR severity improved with decreased anterior (34 ± 5 to 30 ± 4 mm) and posterior PM tethering distance (37 ± 4 to 32 ± 4 mm), anterior leaflet angle (32 ± 8° to 22 ± 7°), and IPMD (31 ± 6 to 25 ± 5 mm), whereas these variables remained abnormal and posterior leaflet angle increased (34 ± 8° to 48 ± 14°; P < .01 for all). During follow-up (66 ± 37 months), these effects were maintained in 33 patients without MR recurrence, whereas 11 with it showed worsened tethering with less LV function recovery. Multiple linear regression analyses identified that change in MR severity from baseline to 12-month examination independently associated with corresponding change in IPMD (parameter estimate of 0.100 with standard error of 0.039; P = .019) and that in posterior PM tethering distance (parameter estimate of -0.104 with standard error of 0.045; P = .035), whereas not with change in posterior-leaflet angle. The IPMD change was independently associated with change in LV end-systolic dimension (parameter estimate of 0.299 with standard error of 0.110; P = .013). CONCLUSIONS The RMA procedure partially relieved leaflet tethering, evidenced by decreased tethering distances and IPMD; the latter was the main determinant of MR. These beneficial effects might be mainly attributed to post-RMA reverse LV remodeling, potentially offsetting the negative effect of augmented posterior leaflet angle in selected patients.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan; Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toshihiro Funatsu
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Haruhiko Kondoh
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Takenori Yokota
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Shusaku Maeda
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yasuhiro Shudo
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan; Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hajime Matsue
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan; Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masami Nishino
- Department of Cardiology, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Takashi Daimon
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan; Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuhiro Taniguchi
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan.
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14
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Mihos CG, Xydas S, Yucel E, Capoulade R, Williams RF, Mawad M, Garcia G, Santana O. Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies. J Thorac Dis 2017; 9:S582-S594. [PMID: 28740711 DOI: 10.21037/jtd.2017.05.56] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Combining a ring annuloplasty (Ring) with a mitral subvalvular intervention (Ring + subvalvular) in patients with secondary mitral regurgitation (MR) may improve mitral valve (MV) repair durability. However, the outcomes of this strategy compared with a Ring only, have not been clearly defined. METHODS A systematic review and meta-analysis was performed utilizing randomized controlled and propensity matched studies which compared a Ring + subvalvular versus Ring MV repair for the treatment of secondary MR. Risk ratio (RR), weighted mean difference (MD), and the 95% confidence interval (CI) were calculated by the Mantel-Haenszel and inverse-variance methods, for clinical outcomes and echocardiographic measures of follow-up MR, left ventricular (LV) reverse remodeling, and MV apparatus geometry. RESULTS Five studies were identified, with a total of 397 patients. Baseline characteristics were similar between groups, and all patients had moderate to severe secondary MR, with the vast majority in the setting of ischemic cardiomyopathy. A Ring + subvalvular repair consisted of papillary muscle approximation (n=2), papillary muscle relocation (n=2), or secondary chordal cutting (n=1). Follow-up ranged from 10.1 (mean range =0.25-42) to 69 [interquartile range (IQR) =23-82] months. When compared with Ring only at last follow-up, a Ring + subvalvular MV repair was associated with: (I) a smaller MR grade (MD =-0.44, 95% CI -0.69 to -0.19; P=0.0005); (II) a reduced risk of moderate or greater recurrent MR (RR =0.43, 95% CI, 0.27-0.66; P=0.0002); (III) a smaller mean LV end-diastolic diameter (MD =-3.56 mm, 95% CI -5.40 to -1.73; P=0.0001) and a greater ejection fraction (MD =2.64%, 95% CI, 0.13-5.15; P=0.04); and, (IV) an improved MV apparatus geometry. There were no differences in operative mortality, post-operative morbidity, or follow-up survival between surgical approaches. CONCLUSIONS When compared with Ring only, a Ring + subvalvular MV repair is associated with greater LV reverse remodeling and systolic function, less recurrence of moderate or greater MR, and an improved geometry of the MV apparatus at short and mid-term follow-up.
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Affiliation(s)
- Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steve Xydas
- Columbia University Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Romain Capoulade
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Roy F Williams
- Columbia University Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Maurice Mawad
- Columbia University Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Guillermo Garcia
- Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
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15
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Mihos CG, Yucel E, Santana O. The role of papillary muscle approximation in mitral valve repair for the treatment of secondary mitral regurgitation. Eur J Cardiothorac Surg 2017; 51:1023-1030. [PMID: 28040676 DOI: 10.1093/ejcts/ezw384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/26/2016] [Indexed: 01/28/2023] Open
Abstract
Secondary mitral regurgitation (MR) is present in up to half of patients with dilated cardiomyopathy, and is associated with a poor prognosis. It primarily results from progressive left ventricular remodelling, papillary muscle displacement and tethering of the mitral valve leaflets. Mitral valve repair with an undersized ring annuloplasty is the reparative procedure of choice in the treatment of secondary MR. However, this technique is associated with a 30-60% incidence of recurrent moderate or greater MR at mid-term follow-up, which results in progressive deterioration of left ventricular function and increased morbidity. Combined mitral valve repair and papillary muscle approximation has been applied in order to address both the annular and subvalvular dysfunction that coexist in secondary MR, which include graft and suture-based techniques. Herein, we provide a systematic review of the published literature regarding the technical aspects, clinical application, and outcomes of mitral valve repair with combined ring annuloplasty and papillary muscle approximation for the treatment of secondary MR.
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Affiliation(s)
- Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Orlando Santana
- The Division of Cardiology at Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA
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16
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Capoulade R, Piriou N, Serfaty JM, Le Tourneau T. Multimodality imaging assessment of mitral valve anatomy in planning for mitral valve repair in secondary mitral regurgitation. J Thorac Dis 2017; 9:S640-S660. [PMID: 28740719 PMCID: PMC5505945 DOI: 10.21037/jtd.2017.06.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 12/23/2022]
Abstract
Secondary mitral regurgitation (MR) is frequent valvular heart disease and conveys worse prognostic. Therapeutic surgical or percutaneous options are available in the context of severe symptomatic secondary MR, but the best approach to treat these patients remains unclear, given the lack of clear clinical evidence of benefit. A comprehensive evaluation of the mitral valve apparatus and the left ventricle (LV) has the ability to clearly define and characterize the disease, and thus determine the best option for the patient to improve its clinical outcomes, as well as quality of life and symptoms. The current report reviews the mitral valve (MV) anatomy, the underlying mechanisms associated with secondary MR, the related therapeutic options available, and finally the usefulness of a multimodality imaging approach for the planning of surgical or percutaneous mitral valve intervention.
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Affiliation(s)
- Romain Capoulade
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Institut du Thorax, CHU Nantes, Nantes University, Nantes, France
| | - Nicolas Piriou
- Institut du Thorax, CHU Nantes, Nantes University, Nantes, France
- Department of Nuclear Medicine, CHU Nantes, Nantes University, Nantes, France
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17
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Capoulade R, Zeng X, Overbey JR, Ailawadi G, Alexander JH, Ascheim D, Bowdish M, Gelijns AC, Grayburn P, Kron IL, Levine RA, Mack MJ, Melnitchouk S, Michler RE, Mullen JC, O'Gara P, Parides MK, Smith P, Voisine P, Hung J. Impact of Left Ventricular to Mitral Valve Ring Mismatch on Recurrent Ischemic Mitral Regurgitation After Ring Annuloplasty. Circulation 2017; 134:1247-1256. [PMID: 27777294 DOI: 10.1161/circulationaha.115.021014] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/29/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND In ischemic mitral regurgitation (IMR), ring annuloplasty is associated with a significant rate of recurrent MR. Ring size is based on intertrigonal distance without consideration of left ventricular (LV) size. However, LV size is an important determinant of mitral valve (MV) leaflet tethering before and after repair. We aimed to determine whether LV-MV ring mismatch (mismatch of LV size relative to ring size) is associated with recurrent MR in patients with IMR after restrictive ring annuloplasty. METHODS Patients with moderate or severe IMR from the 2 Cardiothoracic Surgical Trials Network IMR trials who received MV repair were examined at 1 year after surgery. Baseline LV size was assessed by LV end-diastolic dimension and LV end-systolic dimension (LVESd). LV-MV ring mismatch was calculated as the ratio of LV to ring size (LV end-diastolic dimension/ring size and LVESd/ring size). RESULTS At 1 year after ring annuloplasty, 45 of 214 patients with MV repair (21%) had moderate or greater MR. In univariable logistic regression analysis, larger LVESd (P=0.02) and LVESd/ring size (P=0.007) were associated with recurrent MR. In multivariable models adjusted for age, sex, baseline LV ejection fraction, and severe IMR, only LVESd/ring size (odd ratio per 0.5 increase, 2.20; 95% confidence interval, 1.05-4.62; P=0.038) remained significantly associated with 1-year MR recurrence. CONCLUSIONS LV-MV ring size mismatch is associated with increased risk of MR recurrence. This finding may be helpful in guiding choice of ring size to prevent recurrent MR in patients undergoing MV repair and in identifying patients who may benefit from MV repair with additional subvalvular intervention or MV replacement rather than repair alone. CLINICAL TRIAL REGISTRATION URL:http://clinicaltrials.gov. Unique identifiers: NCT00806988 and NCT00807040.
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Affiliation(s)
- Romain Capoulade
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Xin Zeng
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Jessica R Overbey
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Gorav Ailawadi
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - John H Alexander
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Deborah Ascheim
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Michael Bowdish
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Annetine C Gelijns
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Paul Grayburn
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Irving L Kron
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Robert A Levine
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Michael J Mack
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Serguei Melnitchouk
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Robert E Michler
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - John C Mullen
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Patrick O'Gara
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Michael K Parides
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Peter Smith
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Pierre Voisine
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Judy Hung
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.).
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Mihos CG, Yucel E, Santana O. Left ventricle-mitral valve ring size mismatch: understanding the limitations of mitral valve repair for ischemic mitral regurgitation. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:19. [PMID: 28164104 DOI: 10.21037/atm.2016.12.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Orlando Santana
- The Division of Cardiology at Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA
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Fundarò P, Tartara PM, Villa E, Fratto P, Campisi S, Vitali EO. Mitral Valve Repair: Is There Still a Place for Suture Annuloplasty? Asian Cardiovasc Thorac Ann 2016; 15:351-8. [PMID: 17664215 DOI: 10.1177/021849230701500420] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prosthetic ring annuloplasty is considered the gold standard technique for mitral valve repair, but it has been associated with some drawbacks. Suture annuloplasty is less expensive and may have some physiopathologic advantages. We reviewed the literature to assess clinical results of mitral suture annuloplasty. Thirteen series, each reporting more than 50 patients and published in the last 10 years, were included in the analysis. They comprised 1,648 patients with cumulative follow-up of 5,607 patient-years. Our review suggests that suture annuloplasty is a safe procedure, but a trend toward recurrence of annular dilatation with time was reported. In selected cases, suture annuloplasty is effective, and its mid-term clinical results are encouraging and compare well with those of prosthetic ring repair series. The quality of the results varies according to the particular annuloplasty technique used and to the mitral valve pathology treated. Recent technical modifications have been found to decrease the incidence of repair failure and promise to improve the reproducibility of the procedure. Further investigations are warranted to better assess the long-term results of suture annuloplasty, and to determine whether its theoretical functional advantages translate into a real clinical benefit.
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Affiliation(s)
- Pino Fundarò
- Department of Cardiac Surgery, Ospedale Niguarda Cà Granda, Milan, Italy
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20
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A Systematic Review of Mitral Valve Repair With Autologous Pericardial Leaflet Augmentation for Rheumatic Mitral Regurgitation. Ann Thorac Surg 2016; 102:1400-5. [PMID: 27319989 DOI: 10.1016/j.athoracsur.2016.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/27/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022]
Abstract
A systematic review was conducted to assess the efficacy of mitral valve repair using glutaraldehyde-treated autologous pericardial leaflet augmentation for rheumatic mitral regurgitation (MR). Five retrospective studies were identified, which included 196 patients with moderate or greater MR. There was 1 operative death (0.5%). At a mean follow-up of 3.2 ± 2.2 years, moderate or greater MR reoccurred in 22 patients (11.2%), reoperation was required in 9 (4.6%), and the cumulative survival was 98.9%. Finally, outcomes were similar between the patients who underwent augmentation of the anterior vs the posterior mitral leaflet. Pericardial leaflet augmentation is a viable technique for the treatment of rheumatic MR.
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21
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Suh YJ, Chang BC, Im DJ, Kim YJ, Hong YJ, Hong GR, Kim YJ. Assessment of mitral annuloplasty ring by cardiac computed tomography: Correlation with echocardiographic parameters and comparison between two different ring types. J Thorac Cardiovasc Surg 2015; 150:1082-90. [DOI: 10.1016/j.jtcvs.2015.07.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 06/25/2015] [Accepted: 07/03/2015] [Indexed: 01/20/2023]
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22
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Wan S, Lee APW, Jin CN, Wong RHL, Chan HHM, Ng CSH, Wan IYP, Underwood MJ. The choice of mitral annuloplastic ring-beyond "surgeon's preference". Ann Cardiothorac Surg 2015; 4:261-5. [PMID: 26309828 DOI: 10.3978/j.issn.2225-319x.2015.01.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 12/15/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Song Wan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alex P W Lee
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Chun-Na Jin
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Randolph H L Wong
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Herman H M Chan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Calvin S H Ng
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Innes Y P Wan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Malcolm J Underwood
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Esposito G, Cappabianca G, Bichi S, Cricco A, Poloni C, Beghi C. Sub-valvular repair of ischemic mitral regurgitation in a patient with severe tethering of mitral leaflets. Ann Cardiothorac Surg 2015; 4:384-6. [PMID: 26309851 DOI: 10.3978/j.issn.2225-319x.2015.04.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 03/30/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Giampiero Esposito
- 1 Cardiac Surgery Department, Humanitas Gavazzeni Hospital, Bergamo, Italy ; 2 Cardiac Surgery Department, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giangiuseppe Cappabianca
- 1 Cardiac Surgery Department, Humanitas Gavazzeni Hospital, Bergamo, Italy ; 2 Cardiac Surgery Department, Circolo Hospital, University of Insubria, Varese, Italy
| | - Samuele Bichi
- 1 Cardiac Surgery Department, Humanitas Gavazzeni Hospital, Bergamo, Italy ; 2 Cardiac Surgery Department, Circolo Hospital, University of Insubria, Varese, Italy
| | - Antonio Cricco
- 1 Cardiac Surgery Department, Humanitas Gavazzeni Hospital, Bergamo, Italy ; 2 Cardiac Surgery Department, Circolo Hospital, University of Insubria, Varese, Italy
| | - Camillo Poloni
- 1 Cardiac Surgery Department, Humanitas Gavazzeni Hospital, Bergamo, Italy ; 2 Cardiac Surgery Department, Circolo Hospital, University of Insubria, Varese, Italy
| | - Cesare Beghi
- 1 Cardiac Surgery Department, Humanitas Gavazzeni Hospital, Bergamo, Italy ; 2 Cardiac Surgery Department, Circolo Hospital, University of Insubria, Varese, Italy
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Abstract
PURPOSE Regional heterogeneity in mitral annular contraction, which is generally ascribed to the fibrous vs. muscular annular composition, ensures proper leaflet motion and timing of coaptation. It is unknown whether the fibroblast-like cells in the annulus modulate this heterogeneity, even though valvular interstitial cells (VICs) can be mechanically "activated." METHODS Fourteen sheep underwent implantation of radiopaque markers around the mitral annulus defining four segments: septal (SEPT), lateral (LAT), and anterior (ANT-C) and posterior (POST-C) commissures. Segmental annular contraction was calculated using biplane videofluoroscopy. Immunohistochemistry of annular cross sections assessed regional matrix content, matrix turnover, and cell phenotype. Micropipette aspiration measured the Young's modulus of the leaflets adjacent to the myocardial border. RESULTS Whereas SEPT contained more collagen I and III, LAT demonstrated more collagen and elastin turnover as shown by greater decorin, lysyl oxidase, and matrix metalloprotease (MMP)-13 and smooth muscle alpha-actin (SMaA). This greater matrix turnover paralleled greater annular contraction in LAT vs. SEPT (22.5% vs. 4.1%). Similarly, POST-C had more SMaA and MMP13 than ANT-C, consistent with greater annular contraction in POST-C (18.8% vs. 11.1%). Interestingly, POST-C had the greatest effective modulus, significantly higher than LAT. CONCLUSIONS These data suggest that matrix turnover by activated VICs relates to annular motion heterogeneity, maintains steady-state mechanical properties in the annulus, and could be a therapeutic target when annular motion is impaired. Conversely, alterations in this heterogeneous annular contraction, whether through disease or secondary to ring annuloplasty, could disrupt this normal pattern of cell-mediated matrix remodeling and further adversely impact mitral valve function.
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Bouma W, Aoki C, Vergnat M, Pouch AM, Sprinkle SR, Gillespie MJ, Mariani MA, Jackson BM, Gorman RC, Gorman JH. Saddle-Shaped Annuloplasty Improves Leaflet Coaptation in Repair for Ischemic Mitral Regurgitation. Ann Thorac Surg 2015; 100:1360-6. [PMID: 26184554 DOI: 10.1016/j.athoracsur.2015.03.096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/26/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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.
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Affiliation(s)
- Wobbe Bouma
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania; University of Groningen, University Medical Center Groningen, Department of Cardiothoracic Surgery, Groningen, Netherlands
| | - Chikashi Aoki
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mathieu Vergnat
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alison M Pouch
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shanna R Sprinkle
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew J Gillespie
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Massimo A Mariani
- University of Groningen, University Medical Center Groningen, Department of Cardiothoracic Surgery, Groningen, Netherlands
| | - Benjamin M Jackson
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania.
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Maslow A. Mitral Valve Repair: An Echocardiographic Review: Part 2. J Cardiothorac Vasc Anesth 2015; 29:439-71. [DOI: 10.1053/j.jvca.2014.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Indexed: 12/12/2022]
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Fino C, Iacovoni A, Ferrero P, Merlo M, Bellavia D, D'Elia E, Miceli A, Senni M, Caputo M, Ferrazzi P, Galletti L, Magne J. Determinants of functional capacity after mitral valve annuloplasty or replacement for ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2015; 149:1595-603. [PMID: 25886713 DOI: 10.1016/j.jtcvs.2015.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/26/2015] [Accepted: 03/07/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To identify the exercise echocardiographic determinants of long-term functional capacity, in patients with chronic ischemic mitral regurgitation, after restrictive mitral valve annuloplasty (RMA) or mitral valve replacement (MVR). METHODS We retrospectively analyzed 121 patients with significant chronic ischemic mitral regurgitation, who underwent RMA (n = 62) or MVR (n = 59), between 2005 and 2011. Preoperatively, all patients underwent a resting echocardiographic examination, and a 6-minute walking test (6-MWT) to measure distance. Resting and exercise stress echocardiography, and the 6-MWT were repeated at 41 ± 16.5 months. RESULTS After surgery, the 6-MWT distance significantly improved in the MVR group, and decreased in the RMA group (+37 ± 39 m vs -24 ± 49 m, respectively; P < .0001). Exercise indexed effective orifice area was significantly higher in the MVR, versus the RMA, group (MVR: change from 1.3 ± 0.2 cm(2)/m(2) to 1.5 ± 0.3 cm(2)/m(2); RMA: change from 1.1 ± 0.3 cm(2)/m(2) to 1.2 ± 0.3 cm(2)/m(2); P = .001). The mean mitral gradients significantly increased from rest to exercise, in both groups, but to a greater extent in the RMA group (change from 4.4 ± 1.4 to 11 ± 3.6 mm Hg; MVR: change from 4.3 ± 1.8 to 9 ± 3.5 mm Hg; P = .006). On multivariate analysis, MVR and exercise indexed effective orifice area were the main independent determinants of postoperative 6-MWT. In the RMA group, 25 patients experienced late mitral regurgitation recurrence, severe in 9 (14%) of them. The rate of postoperative cardiovascular events was significantly higher in the RMA group (21% vs MVR: 8%; P = .03). Follow-up survival was 83% in the RMA group and 88% in the MVR group (P = .54). CONCLUSIONS For chronic ischemic mitral regurgitation, MVR versus RMA was associated with better postoperative exercise hemodynamic performance and long-term functional capacity.
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Affiliation(s)
- Carlo Fino
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Attilio Iacovoni
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Ferrero
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Merlo
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Diego Bellavia
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Emilia D'Elia
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio Miceli
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Michele Senni
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Paolo Ferrazzi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - L Galletti
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Julien Magne
- Cardiology Department, Hôpital Dupuytren, Le Centre Hospitalier et Universitaire de Limoges (CHU Limoges), Limoges, France.
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28
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Khamooshian A, Buijsrogge MP, De Heer F, Gründeman PF. Mitral Valve Annuloplasty Rings: Review of Literature and Comparison of Functional Outcome and Ventricular Dimensions. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:399-415. [DOI: 10.1177/155698451400900603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the past decades, more than 40 mitral valve annuloplasty rings of various shapes and consistency were marketed for mitral regurgitation (MR), although the effect of ring type on clinical outcome remains unclear. Our objective was to review the literature and apply a simplification method to make rings of different shapes and rigidity more comparable. We studied relevant literature from MEDLINE and EMBASE databases related to clinical studies as well as animal and finite element models. Annuloplasty rings were clustered into 3 groups as follows: rigid (R), flexible (F), and semirigid (S). Only clinical articles regarding degenerative (DEG) or ischemic/dilated cardiomyopathy (ICM) MR were included and stratified into these groups. A total of 37 rings were clustered into R, F, and S subgroups. Clinical studies with a mean follow-up of less than 1 year and a reported mean etiology of valve incompetence of less than 60% were excluded from the analysis. Forty-one publications were included. Preimplant and postimplant end points were New York Heart Association class, left ventricular ejection fraction (LVEF), left ventricular end-systolic dimension (LVESD), and left ventricular end-diastolic dimension (LVEDD). Statistical analysis included paired-samples t test and analysis of variance with post hoc Bonferroni correction. P < 0.05 indicated statistical difference. Mean ± SD follow-up was 38.6 ± 27 and 29.7 ± 13.2 months for DEG and ICM, respectively. In DEG, LVEF remained unchanged, and LVESD decreased in all subgroups. In our analysis, LVEDD decreased only in F and R, and S did not change; however, the 4 individual studies showed a significant decline. In ICM, New York Heart Association class improved in all subgroups, and LVEF increased. Moreover, LVESD and LVEDD decreased only in F and S; R was underpowered (1 study). No statistical difference among R, F, and S in either ICM or DEG could be detected for all end points. Overall, owing to underpowered data sets derived from limited available publications, major statistical differences in clinical outcome between ring types could not be substantiated. Essential end points such as recurrent MR and survival were incomparable. In conclusion, ring morphology and consistency do not seem to play a major clinical role in mitral valve repair based on the present literature. Hence, until demonstrated otherwise, surgeons may choose their ring upon their judgment, tailored to specific patient needs.
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Fino C, Iacovoni A, Ferrero P, Senni M, Merlo M, Cugola D, Ferrazzi P, Caputo M, Miceli A, Magne J. Restrictive mitral valve annuloplasty versus mitral valve replacement for functional ischemic mitral regurgitation: An exercise echocardiographic study. J Thorac Cardiovasc Surg 2014; 148:447-53.e2. [DOI: 10.1016/j.jtcvs.2013.05.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/16/2013] [Accepted: 05/31/2013] [Indexed: 11/29/2022]
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Esposito G, Cappabianca G, Bichi S, Patrini D. Tailored repair of the subvalvular apparatus using 'cut and transfer' technique in patients with chronic ischaemic mitral regurgitation and severe tethering of the mitral leaflets. Eur J Cardiothorac Surg 2014; 46:321-3. [PMID: 24499876 DOI: 10.1093/ejcts/ezu003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tethering of both mitral leaflets is the predominant mechanism of mitral regurgitation in patients with chronic ischaemic cardiomyopathy. For patients with severe mitral leaflet tethering, we have developed a surgical approach alternative to the conventional undersized annuloplasty ring that targets the subvalvular apparatus and aims to reconstitute the leaflet coaptation by reducing leaflet tethering in three steps, including the translocation of secondary chordae of the anterior leaflet in primary position, the relocation of the posterior papillary muscle closer to the mitral annulus and the plication of the lateral wall of the left ventricle when a large infarcted area was present. All repairs were completed by a 'true-sized' annuloplasty ring. In this paper, we present the indications, the technical aspects and the initial results of this tailored approach in 53 patients with moderate to severe chronic ischaemic mitral regurgitation and severe leaflet tethering.
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Affiliation(s)
- Giampiero Esposito
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | | | - Samuele Bichi
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Davide Patrini
- Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
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Bhattacharya S, Pham T, He Z, Sun W. Tension to passively cinch the mitral annulus through coronary sinus access: an ex vivo study in ovine model. J Biomech 2014; 47:1382-8. [PMID: 24607007 DOI: 10.1016/j.jbiomech.2014.01.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The transcatheter mitral valve repair (TMVR) technique utilizes a stent to cinch a segment of the mitral annulus (MA) and reduces mitral regurgitation. The cinching mechanism results in reduction of the septal-lateral distance. However, the mechanism has not been characterized completely. In this study, a method was developed to quantify the relation between cinching tension and MA area in an ex vivo ovine model. METHOD The cinching tension was measured from a suture inserted within the coronary sinus (CS) vessel with one end tied to the distal end of the vessel and the other end exited to the CS ostium where it was attached to a force transducer on a linear stage. The cinching tension, MA area, septal-lateral (S-L) and commissure-commissure (C-C) diameters and leakage was simultaneously measured in normal and dilated condition, under a hydrostatic left ventricular pressure of 90 mm Hg. RESULTS The MA area was increased up to 22.8% after MA dilation. A mean tension of 2.1 ± 0.5 N reduced the MA area by 21.3 ± 5.6% and S-L diameter by 24.2 ± 5.3%. Thus, leakage was improved by 51.7 ± 16.2% following restoration of normal MA geometry. CONCLUSION The cinching tension generated by the suture acts as a compensation force in MA reduction, implying the maximum tension needed to be generated by annuloplasty device to restore normal annular size. The relationship between cinching tension and the corresponding MA geometry will contribute to the development of future TMVR devices and understanding of myocardial contraction function.
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Affiliation(s)
- Shamik Bhattacharya
- Tissue Mechanics Laboratory Biomedical Engineering Program and Department of Mechanical Engineering University of Connecticut, Storrs, CT 06269, United States
| | - Thuy Pham
- Tissue Mechanics Laboratory Biomedical Engineering Program and Department of Mechanical Engineering University of Connecticut, Storrs, CT 06269, United States
| | - Zhaoming He
- Department of Mechanical Engineering Texas Tech University, Lubbock, TX 79409, United States
| | - Wei Sun
- Tissue Mechanics Laboratory Biomedical Engineering Program and Department of Mechanical Engineering University of Connecticut, Storrs, CT 06269, United States.
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Maslow A, Mahmood F, Poppas A, Singh A. Three-Dimensional Echocardiographic Assessment of the Repaired Mitral Valve. J Cardiothorac Vasc Anesth 2014; 28:11-17. [DOI: 10.1053/j.jvca.2013.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Indexed: 12/16/2022]
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Tsang W, Lang RM. Three-dimensional echocardiography is essential for intraoperative assessment of mitral regurgitation. Circulation 2013; 128:643-52; discussion 652. [PMID: 23918185 DOI: 10.1161/circulationaha.112.120501] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wendy Tsang
- Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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Montes L, Silva J, Villagrán E, Garcés Z, Ayaón A, Carnero M, Maroto L, Rodríguez JE. Resultados clínicos y ecocardiográficos de la reparación valvular mitral con el uso de neocuerdas de politetrafluoroetileno expandido. CIRUGIA CARDIOVASCULAR 2013. [DOI: 10.1016/j.circv.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Maslow A, Mahmood F, Singh A, Dobrillovic N, Poppas A. Problems With Excess Mitral Leaflet After Repair: Possible Issues During Repair and Preservation of the Posterior Leaflet. J Cardiothorac Vasc Anesth 2013; 27:92-7. [DOI: 10.1053/j.jvca.2012.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Indexed: 12/31/2022]
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Mizuno T, Mizukoshi T, Uechi M. Long-term outcome in dogs undergoing mitral valve repair with suture annuloplasty and chordae tendinae replacement. J Small Anim Pract 2012; 54:104-7. [PMID: 23146131 DOI: 10.1111/j.1748-5827.2012.01305.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mitral valve repair under cardiopulmonary bypass was performed in three dogs with clinical signs associated with mitral regurgitation that were not controlled by medication. Mitral valve repair comprised circumferential annuloplasty and chordal replacement with expanded polytetrafluoroethylene. One dog died 2 years after surgery because of severe mitral regurgitation resulting from partial circumferential suture detachment. The others survived for over 5 years, but mild mitral valve stenosis persisted in one. The replaced chordae did not rupture in any dog. Mitral valve repair appears to be an effective treatment for mitral regurgitation in dogs. Chordal replacement with expanded polytetrafluoroethylene is a feasible technique, demonstrating long-term durability in dogs. However, mitral annuloplasty techniques need improvement.
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Affiliation(s)
- T Mizuno
- Veterinary Cardiovascular Medicine and Surgery, Laboratory of Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Science, Nihon University, 1866 Fujisawa, Kanagawa, 252-0880, Japan
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Sakamoto Y. Mitral valve mobility. Ann Thorac Cardiovasc Surg 2012; 18:409-11. [PMID: 22971757 DOI: 10.5761/atcs.ed.12.01945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Oertel F, Golczyk K, Pantele S, Danov V, Galiñanes M, Beyer M. Mitral valve restoration using the No-React(R) MitroFix™: a novel concept. J Cardiothorac Surg 2012; 7:82. [PMID: 22947441 PMCID: PMC3494579 DOI: 10.1186/1749-8090-7-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 08/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mitral Valve Repair (MVRP) has been shown to be significantly superior to Mitral Valve Replacement (MVR). Since the majority of repairs involve the Posterior Mitral Leaflet (PML) and not the Anterior Mitral Leaflet (AML), the monocuspidalisation of the Mitral Valve (MV) can be achieved with a bio-posterior leaflet that imitates a closed PML. This approach may have the benefit of restoring the competence of the MV without reducing its effective orifice area. METHODS We have used a new concept and device, the MitroFixTM, to correct MV regurgitation due to pathology of the PML. The device comes with functional sizers both of which have identical shape and size. This allows the surgeon to pre-test the success of the restoration. From December 2006 to October 2011, 51 MitroFixTM devices were implanted at three institutions. RESULTS The mean age of the patients (32 males and 19 females) was 67.7 years. 37 of them were in NYHA class III or IV and all patients suffered from severe mitral valve regurgitation (MR). 31 patients underwent combined surgery. Successful implantation of the MitroFix™ device was performed in 51/53 patients.Mean cross-clamp time was 63.6 min (range: 29-118 min). Six patients had additional reconstructive procedures of the AML (chordae transfer, neo-chordae, triangular resection). At discharge, 33 patients showed no MR in the TTE and 17 patients exhibited trivial (I) or moderate (II) MR. The mean gradient was 4.0 mmHg and mean EOA was 2.52cm^2 (range: 1.5-4.0cm2). All patients were classified as being in NYHA class I or II. CONCLUSION The MitroFixTM Mitral Valve Restoration Device is a new concept that offers an effective treatment of MR. The restoration of the mitral valve with the MitroFix™ device offers the advantage of preserving the AML and providing good coaptation with a prosthetic PML. Importantly, this preliminary evaluation indicates a mean effective orifice area ( EOA ) of 2.5cm2 in MV receiving a MitroFix™ device, witch is higher than EOA resulting from MVR or MVRP. The present study has also shown that severe regurgitation due to ischemic/rheumatic MR, endocarditis and complex prolapse of the PML are clear candidates for correction with the MitroFix™. Larger studies and a longer follow up period are needed to validate these promising results.
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Jassar AS, Minakawa M, Shuto T, Robb JD, Koomalsingh KJ, Levack MM, Vergnat M, Eperjesi TJ, Jackson BM, Gorman JH, Gorman RC. Posterior leaflet augmentation in ischemic mitral regurgitation increases leaflet coaptation and mobility. Ann Thorac Surg 2012; 94:1438-45. [PMID: 22795059 DOI: 10.1016/j.athoracsur.2012.05.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND Restoring leaflet coaptation is the primary objective in repair of ischemic mitral regurgitation (IMR). The common practice of placing an undersized annuloplasty ring partially achieves this goal by correcting annular dilation; however, annular reduction has been demonstrated to exacerbate posterior leaflet tethering. Using a sheep model of IMR, we tested the hypothesis that posterior leaflet augmentation (PLA) combined with standard annuloplasty sizing increases leaflet coaptation more effectively than undersized annuloplasty alone. METHODS Eight weeks after posterobasal myocardial infarction, 15 sheep with 2+ or greater IMR underwent annuloplasty with either a 24-mm annuloplasty ring (24-mm group, n = 5), 30-mm ring (30-mm group, n = 5), or 30-mm ring with concomitant augmentation of the posterior leaflet (PLA group, n = 5). Using three-dimensional echocardiography, postrepair coaptation zone and posterior leaflet mobility were assessed. RESULTS Leaflet coaptation length after repair was greater in the PLA group (4.1 ± 0.3 mm) and the 24-mm group (3.8 ± 0.5 mm) as compared with the 30-mm group (2.7 ± 0.6 mm, p < 0.01). Leaflet coaptation area was significantly greater in the PLA group (121.5 ± 6.6 mm(2)) as compared with the 30-mm group (77.5 ± 17.0 mm(2)) or the 24-mm group (92.5 ± 17.9 mm(2), p < 0.01). Posterior leaflet mobility was significantly greater in the PLA group as compared with the 30-mm group or the 24-mm group. CONCLUSIONS Posterior leaflet augmentation combined with standard-sized annuloplasty enhances leaflet coaptation more effectively than either standard-sized annuloplasty or undersized annuloplasty alone. Increased leaflet coaptation after PLA provides redundancy to IMR repair, and may decrease incidence of both recurrent IMR and mitral stenosis.
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Affiliation(s)
- Arminder S Jassar
- Department of Surgery, University of Pennsylvania, Philadelphia, PA 19036, USA
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40
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Unger P, Magne J, Dedobbeleer C, Lancellotti P. Ischemic mitral regurgitation: not only a bystander. Curr Cardiol Rep 2012; 14:180-9. [PMID: 22203438 DOI: 10.1007/s11886-011-0241-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ischemic mitral regurgitation (MR) is a common complication of left ventricular (LV) dysfunction related to chronic coronary artery disease. This complex multifactorial disease involves global and regional LV remodeling, as well as dysfunction and distortion of the components of the mitral valve including the chordae, the annulus, and the leaflets. Its occurrence is associated with a poor prognosis. The suboptimal results obtained with the most commonly used surgical strategy, involving mitral valve annuloplasty with coronary bypass grafting, emphasize the need to develop alternative surgical techniques targeting the causal mechanisms of the disease. A comprehensive preoperative assessment of mitral valve configuration and LV geometry and function and an accurate quantification of MR severity at rest and during exercise may contribute to improve risk stratification and to tailor the surgical strategy according to the individual characteristics of the patient.
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Affiliation(s)
- Philippe Unger
- Cardiology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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41
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Espino DM, Shepherd DET, Hukins DWL. Evaluation of a transient, simultaneous, arbitrary Lagrange-Euler based multi-physics method for simulating the mitral heart valve. Comput Methods Biomech Biomed Engin 2012; 17:450-8. [PMID: 22640492 DOI: 10.1080/10255842.2012.688818] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A transient multi-physics model of the mitral heart valve has been developed, which allows simultaneous calculation of fluid flow and structural deformation. A recently developed contact method has been applied to enable simulation of systole (the stage when blood pressure is elevated within the heart to pump blood to the body). The geometry was simplified to represent the mitral valve within the heart walls in two dimensions. Only the mitral valve undergoes deformation. A moving arbitrary Lagrange-Euler mesh is used to allow true fluid-structure interaction (FSI). The FSI model requires blood flow to induce valve closure by inducing strains in the region of 10-20%. Model predictions were found to be consistent with existing literature and will undergo further development.
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Affiliation(s)
- Daniel M Espino
- a School of Mechanical Engineering, University of Birmingham , Birmingham , B15 2TT , UK
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42
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Silva J, Blanco E, Maroto LC, Cobiella J, Carnero M, Villagrán E, Montes L, Almería C, Zamorano JL, Rodríguez JE. Resección cuadrangular frente al uso de neocuerdas en la reparación del velo posterior mitral. Resultados clínicos y ecocardiográficos. CIRUGIA CARDIOVASCULAR 2012. [DOI: 10.1016/s1134-0096(12)70037-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Rausch MK, Bothe W, Kvitting JPE, Göktepe S, Miller DC, Kuhl E. In vivo dynamic strains of the ovine anterior mitral valve leaflet. J Biomech 2011; 44:1149-57. [PMID: 21306716 DOI: 10.1016/j.jbiomech.2011.01.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 11/30/2010] [Accepted: 01/18/2011] [Indexed: 11/19/2022]
Abstract
Understanding the mechanics of the mitral valve is crucial in terms of designing and evaluating medical devices and techniques for mitral valve repair. In the current study we characterize the in vivo strains of the anterior mitral valve leaflet. On cardiopulmonary bypass, we sew miniature markers onto the leaflets of 57 sheep. During the cardiac cycle, the coordinates of these markers are recorded via biplane fluoroscopy. From the resulting four-dimensional data sets, we calculate areal, maximum principal, circumferential, and radial leaflet strains and display their profiles on the averaged leaflet geometry. Average peak areal strains are 13.8±6.3%, maximum principal strains are 13.0±4.7%, circumferential strains are 5.0±2.7%, and radial strains are 7.8±4.3%. Maximum principal strains are largest in the belly region, where they are aligned with the circumferential direction during diastole switching into the radial direction during systole. Circumferential strains are concentrated at the distal portion of the belly region close to the free edge of the leaflet, while radial strains are highest in the center of the leaflet, stretching from the posterior to the anterior commissure. In summary, leaflet strains display significant temporal, regional, and directional variations with largest values inside the belly region and toward the free edge. Characterizing strain distribution profiles might be of particular clinical significance when optimizing mitral valve repair techniques in terms of forces on suture lines and on medical devices.
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Affiliation(s)
- Manuel K Rausch
- Department of Mechanical Engineering, School of Engineering, Stanford University, Stanford, CA 94305, USA
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44
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Mechanistic Insights into Ischemic Mitral Regurgitation: Echocardiographic and Surgical Implications. J Am Soc Echocardiogr 2011; 24:707-19. [DOI: 10.1016/j.echo.2011.04.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Indexed: 11/24/2022]
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45
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Vohra HA, Whistance RN, Bezuska L, Livesey SA. Initial experience of mitral valve repair using the Carpentier-Edwards Physio II annuloplasty ring. Eur J Cardiothorac Surg 2011; 39:881-5. [DOI: 10.1016/j.ejcts.2010.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 10/04/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022] Open
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Maslow A, Singh A, Mahmood F, Poppas A. Intraoperative Assessment of Mitral Valve Area After Mitral Valve Repair for Regurgitant Valves. J Cardiothorac Vasc Anesth 2011; 25:486-90. [DOI: 10.1053/j.jvca.2010.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Indexed: 01/16/2023]
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47
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Maslow A, Gemignani A, Singh A, Mahmood F, Poppas A. Intraoperative Assessment of Mitral Valve Area After Mitral Valve Repair: Comparison of Different Methods. J Cardiothorac Vasc Anesth 2011; 25:221-8. [DOI: 10.1053/j.jvca.2010.11.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Indexed: 01/26/2023]
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48
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Jensen MO, Jensen H, Levine RA, Yoganathan AP, Andersen NT, Nygaard H, Hasenkam JM, Nielsen SL. Saddle-shaped mitral valve annuloplasty rings improve leaflet coaptation geometry. J Thorac Cardiovasc Surg 2011; 142:697-703. [PMID: 21329946 DOI: 10.1016/j.jtcvs.2011.01.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 12/17/2010] [Accepted: 01/10/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The mitral valve annulus naturally conforms to a saddle shape in systole. This configuration is believed to put the leaflets into a lower-energy equilibrium with the annulus and subvalvular apparatus. Conventional flat annuloplasty rings restrict posterior leaflet motion, which may result in a "monocusp" valve, affecting valvular stress distribution. It is hypothesized that saddle-shaped annuloplasty rings cause less distortion of the physiologic leaflet geometry than do flat rings. METHODS Twelve pigs were studied in an acute setting with 3-dimensional echocardiography and sonomicrometry before and after implantation of rigid flat (n = 5) and saddle-shaped (n = 7) annuloplasty rings. The rings were true sized to the annulus with equal anterior-posterior and commissure-commissure circumferential dimensions. The saddle-shaped rings had an annular height to commissural width ratio of 15%. RESULTS Saddle-shaped rings maintained both leaflets operational (P < .01). Flat rings made the posterior leaflet immobile and the anterior leaflet aligned flat along the annulus in systole, effectively resulting in monoleaflet function. The average distance from the papillary muscle tips to the posterior annulus decreased by 2.4 ± 0.4 mm after flat ring implantation (P < .01). CONCLUSIONS Saddle-shaped annuloplasty rings provide better leaflet coaptation geometry than do flat rings by not hoisting the papillary muscles toward the posterior annulus through the commissural chordae, allowing greater leaflet mobility. This entails a potentially beneficial impact on valvular stress distribution that could affect durability of the repaired valve.
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Affiliation(s)
- Morten O Jensen
- Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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Ciarka A, Braun J, Delgado V, Versteegh M, Boersma E, Klautz R, Dion R, Bax JJ, Van de Veire N. Predictors of mitral regurgitation recurrence in patients with heart failure undergoing mitral valve annuloplasty. Am J Cardiol 2010; 106:395-401. [PMID: 20643253 DOI: 10.1016/j.amjcard.2010.03.042] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 03/04/2010] [Accepted: 03/04/2010] [Indexed: 11/19/2022]
Abstract
Restrictive mitral annuloplasty is a surgical treatment option for patients with heart failure (HF) and functional mitral regurgitation (MR). However, recurrent MR has been reported at mid-term follow-up. The aim of the present study was to identify the echocardiographic predictors of recurrent MR in patients with HF undergoing mitral annuloplasty. During a mean follow-up of 2.6 +/- 1.6 years, 109 patients with HF (49% ischemic and 51% idiopathic dilated cardiomyopathy) who had undergone mitral valve repair were followed up (of 122 total patients). The severity of MR was quantified, and the following parameters were measured before intervention and at the mid-term follow-up examination: left ventricular (LV) and left atrial volumes and dimensions, LV sphericity index, mitral annular area, and mitral valve geometry parameters. At mid-term follow-up, 21 patients presented with significant MR (grade 2 to 4), and 88 patients had only MR grade 0 to 1. Both groups of patients had had a similar preoperative MR grade, mitral annular area, and LV volume and dimension. In contrast, patients with recurrent MR had had increased preoperative posterior and anterior leaflet angles, tenting height, tenting area, and LV sphericity index compared to the patients without recurrent MR. Of the different parameters of mitral and LV geometry, the distal mitral anterior leaflet angle (hazard ratio 1.48, 95% confidence interval 1.32 to 1.66, p <0.001) and posterior leaflet angle (hazard ratio 1.13, 95% confidence interval 1.07 to 1.19, p <0.001) were independent determinants of MR at mid-term follow-up. In conclusion, in patients with HF of ischemic or idiopathic etiology and functional MR, distal mitral leaflet tethering and posterior mitral leaflet tethering were associated with recurrent MR after restrictive mitral annuloplasty.
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Affiliation(s)
- Agnieszka Ciarka
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Bothe W, Kvitting JPE, Swanson JC, Göktepe S, Vo KN, Ingels NB, Miller DC. How do annuloplasty rings affect mitral leaflet dynamic motion? Eur J Cardiothorac Surg 2010; 38:340-9. [PMID: 20335042 DOI: 10.1016/j.ejcts.2010.02.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 01/31/2010] [Accepted: 02/04/2010] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To define the effects of annuloplasty rings (ARs) on the dynamic motion of anterior mitral leaflet (AML) and posterior mitral leaflet (PML). METHODS Fifty-eight adult, Dorsett-hybrid, male sheep (49 + or - 5 kg) had radiopaque markers inserted: eight around the mitral annulus, four along the central meridian (from edge to annulus) of the AML (#A(1)-#A(4)) and one on the PML edge (#P(1)). True-sized Edwards Cosgrove (COS, n=12), St Jude RSAR (St. Jude Medical, St. Paul, MN, USA) (n=12), Carpentier-Edwards Physio (PHYSIO, n=12), Edwards IMR ETlogix (ETL, n=10) or Edwards GeoForm (GEO, n=12) ARs were implanted in a releasable fashion. Under acute open-chest conditions, 4D marker coordinates were obtained using biplane videofluoroscopy with the respective AR inserted (COS, RSAR, PHYSIO, ETL and GEO) and after release (COS-Control, RSAR-Control, PHYSIO-Control, ETL-Control and GEO-Control). AML and PML excursions were calculated as the difference between minimum and maximum angles between the central mitral annular septal-lateral chord and the AML edge markers (alpha(1exc)-alpha(4exc)) and PML edge marker (beta(1exc)) during the cardiac cycle. RESULTS Relative to Control, (1) RSAR, PHYSIO, ETL and GEO increased excursion of the AML annular (alpha(4exc): 13 + or - 6 degrees vs 16 + or - 7 degrees *, 16 + or - 7 degrees vs 23 + or - 10 degrees *, 12 + or - 4 degrees vs 18 + or - 9 degrees *, 15 + or - 1 degrees vs 20 + or - 9 degrees *, respectively) and belly region (alpha(2exc): 41 + or - 10 degrees vs 45 + or - 10 degrees *, 42 + or - 8 degrees vs 45 + or - 6 degrees , n.s., 33 + or - 13 degrees vs 42 + or - 14 degrees *, 39 + or - 6 degrees vs 44 + or - 6 degrees *, respectively, alpha(3exc): 24 + or - 9 degrees vs 29 + or - 11 degrees *, 28 + or - 10 degrees vs 33 + or - 10 degrees *, 16 + or - 9 degrees vs 21 + or - 12 degrees *, 25 + or - 7 degrees vs 29 + or - 9 degrees *, respectively), but not of the AML edge (alpha(1exc): 42 + or - 8 degrees vs 44 + or - 8 degrees , 43 + or - 8 degrees vs 41 + or - 6 degrees , 42 + or - 11 vs 46 + or - 10 degrees , 39 + or - 9 degrees vs 38 + or - 8 degrees , respectively, all n.s.). COS did not affect AML excursion (alpha(1exc): 40 + or - 8 degrees vs 37 + or - 8 degrees , alpha(2exc): 43 + or - 9 degrees vs 41 + or - 9 degrees , alpha(3exc): 27 + or - 11 degrees vs 27 + or - 10 degrees , alpha(4exc): 18 + or - 8 degrees vs 17 + or - 7 degrees , all n.s.). (2) PML excursion (beta(1exc)) was reduced with GEO (53 + or - 5 degrees vs 43 + or - 6 degrees *), but unchanged with COS, RSAR, PHYSIO or ETL (53 + or - 13 degrees vs 52 + or - 15 degrees , 50 + or - 13 degrees vs 49 + or - 10 degrees , 55 + or - 5 degrees vs 55 + or - 7 degrees , 52 + or - 8 degrees vs 58 + or - 6 degrees , respectively, all n.s); *=p<0.05. CONCLUSIONS RSAR, PHYSIO, ETL and GEO rings, but not COS, increase AML excursion of the AML annular and belly region, suggesting higher anterior mitral leaflet bending stresses with rigid rings, which potentially could be deleterious with respect to repair durability. The decreased PML excursion observed with GEO could impair left ventricular filling. Clinical studies are needed to validate these findings in patients.
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Affiliation(s)
- Wolfgang Bothe
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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