TY - JOUR
T1 - Saddle-shape annuloplasty increases mitral leaflet coaptation after repair for flail posterior leaflet
AU - Vergnat, Mathieu
AU - Jackson, Benjamin M.
AU - Cheung, Albert T.
AU - Weiss, Stuart J.
AU - Ratcliffe, Sarah J.
AU - Gillespie, Mathew J.
AU - Woo, Y. Joseph
AU - Bavaria, Joseph E.
AU - Acker, Michael A.
AU - Gorman, Robert C.
AU - Gorman, Joseph H.
N1 - Funding Information:
This research project was supported by grants from the National Heart, Lung and Blood Institute of the National Institutes of Health , Bethesda, MD ( HL63954 and HL73021 ). It was also supported by an investigator-initiated grant from Medtronic , Minneapolis, MN. Robert Gorman and Joseph Gorman were supported by individual Established Investigator Awards from the American Heart Association, Dallas, TX. Mathieu Vergnat was supported by a French Federation of Cardiology Research Grant .
PY - 2011/9
Y1 - 2011/9
N2 - Background: The primary goal of surgical mitral repair is the reestablishment of normal leaflet coaptation. Surgical techniques that maintain or restore leaflet geometry promote leaflet coaptation. Recent 3-dimensional (3D) echocardiographic studies have shown that saddle-shaped annuloplasty has a salutary influence on leaflet geometry. Therefore we hypothesized that saddle-shaped annuloplasty would improve leaflet coaptation in cases of repair for flail posterior leaflet segments. Methods: Sixteen patients with flail posterior segment and severe mitral regurgitation had valve repair using standard techniques. Eight patients received saddle-shaped annuloplasty and 8 patients received flat annuloplasty. Real-time 3D transesophageal echocardiography was performed before and after repair. Images were analyzed using custom software to calculate mitral annular area (MAA), septolateral dimension (SLD), intercommissural width (CW), total leaflet area (TLA), and leaflet coaptation area (LCA). Results: Postrepair MAA (flat, 588.6 ± 26.5 mm2; saddle, 628.0 ± 35.3 mm2; p = 0.12) and TLA (flat, 2198.5 ± 151.6 mm2; saddle, 2303.9 ± 183.8 mm2; p = 0.67) were similar in both groups. Postrepair LCA was significantly greater in the saddle group than in the flat group (226.8 ± 24.0 mm2 and 154.0 ± 13.0 mm2, respectively; p = 0.02). Conclusions: Real-time 3D echocardiography and novel imaging software provide a powerful tool for analyzing mitral leaflet coaptation. When compared with flat annuloplasty, saddle-shaped annuloplasty improves LCA after mitral valve repair for severe mitral regurgitation secondary to flail posterior leaflet segment. Use of saddle-shaped annuloplasty devices may increase repair durability.
AB - Background: The primary goal of surgical mitral repair is the reestablishment of normal leaflet coaptation. Surgical techniques that maintain or restore leaflet geometry promote leaflet coaptation. Recent 3-dimensional (3D) echocardiographic studies have shown that saddle-shaped annuloplasty has a salutary influence on leaflet geometry. Therefore we hypothesized that saddle-shaped annuloplasty would improve leaflet coaptation in cases of repair for flail posterior leaflet segments. Methods: Sixteen patients with flail posterior segment and severe mitral regurgitation had valve repair using standard techniques. Eight patients received saddle-shaped annuloplasty and 8 patients received flat annuloplasty. Real-time 3D transesophageal echocardiography was performed before and after repair. Images were analyzed using custom software to calculate mitral annular area (MAA), septolateral dimension (SLD), intercommissural width (CW), total leaflet area (TLA), and leaflet coaptation area (LCA). Results: Postrepair MAA (flat, 588.6 ± 26.5 mm2; saddle, 628.0 ± 35.3 mm2; p = 0.12) and TLA (flat, 2198.5 ± 151.6 mm2; saddle, 2303.9 ± 183.8 mm2; p = 0.67) were similar in both groups. Postrepair LCA was significantly greater in the saddle group than in the flat group (226.8 ± 24.0 mm2 and 154.0 ± 13.0 mm2, respectively; p = 0.02). Conclusions: Real-time 3D echocardiography and novel imaging software provide a powerful tool for analyzing mitral leaflet coaptation. When compared with flat annuloplasty, saddle-shaped annuloplasty improves LCA after mitral valve repair for severe mitral regurgitation secondary to flail posterior leaflet segment. Use of saddle-shaped annuloplasty devices may increase repair durability.
UR - http://www.scopus.com/inward/record.url?scp=80052806344&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2011.04.047
DO - 10.1016/j.athoracsur.2011.04.047
M3 - Article
C2 - 21803330
AN - SCOPUS:80052806344
SN - 0003-4975
VL - 92
SP - 797
EP - 803
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -