Annular Dynamics and Leaflet Geometry in Patch Reconstruction of the Posterior Mitral Leaflet After Adding a Flexible Annuloplasty Ring,Cardiovascular Engineering and Technology

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Annular Dynamics and Leaflet Geometry in Patch Reconstruction of the Posterior Mitral Leaflet After Adding a Flexible Annuloplasty Ring
Cardiovascular Engineering and Technology ( IF 1.8 ) Pub Date : 2020-11-16 , DOI: 10.1007/s13239-020-00502-x
Karen B Poulsen _{1,

2} , Marcell J Tjørnild _{1,

2} , Søren N Skov _{1,

2} , Mona Sharghbin _{1,

2} , Lisa Carlson Hanse _{1,

2} , Leila L Benhassen _{1,

2} , Diana M Røpcke _{1,

2} , Sten L Nielsen _{1,

2} , J Michael Hasenkam _{1,

2}

Affiliation

Purpose

Patch reconstruction of the posterior mitral leaflet using small intestinal submucosa extracellular matrix has been successfully performed in a porcine study. The patch reconstruction, however, resulted in non-physiological systolic widening of the mitral annulus, suggesting the need for an annuloplasty ring. The objective was to characterize the impact on annular dynamics and leaflet geometry of adding a flexible annuloplasty ring to the posterior mitral leaflet patch reconstruction.

Methods

Measurements were performed in an acute 80-kg porcine model, with seven pigs acting as their own controls. The posterior mitral leaflet was reconstructed with a 2-ply small intestinal submucosa extracellular matrix patch (CorMatrix®). Additionally, a Simulus® Flexible Annuloplasty Ring (Medtronic Inc., Minneapolis, MN, USA) was inserted. Mitral annular dynamics were evaluated using sonomicrometry, and leaflet geometry was described using echocardiography.

Results

The annuloplasty ring reduced mitral annular dimensions and restricted cyclic changes in mitral annular area (126 ± 19 vs. 30 ± 13 mm², p < 0.001), septal-lateral and commisure-commisure distances. Ring annuloplasty prevented systolic widening in the mitral annulus after posterior mitral leaflet reconstruction. The annular saddle shape and leaflet coaptation length (8.7 ± 2.3 vs. 9.7 ± 1.3 mm, p = 0.221) were comparable before and after ring insertion.

Conclusions

The flexible annuloplasty ring resulted in a downsized annulus with restriction of cyclic annular changes in the reconstructed mitral valve. Ring insertion preserved the annular saddle shape and coaptation length. The ring annuloplasty counteracted the non-physiological annular dynamics, and this may improve durability of the posterior mitral leaflet patch reconstruction.

中文翻译：

添加柔性瓣环成形术环后二尖瓣后叶贴片重建中的环动力学和瓣叶几何形状

目的

使用小肠黏膜下层细胞外基质对二尖瓣后叶进行贴片重建已在一项猪研究中成功进行。然而，补片重建导致二尖瓣环非生理性收缩期扩大，表明需要瓣环成形术环。目的是表征在后二尖瓣瓣叶补片重建中添加柔性瓣环成形术环对瓣环动力学和瓣叶几何形状的影响。

方法

测量是在一个 80 公斤的急性猪模型中进行的，其中 7 头猪作为它们自己的对照。二尖瓣后叶用 2 层小肠粘膜下层细胞外基质补片 (CorMatrix®) 重建。此外，还插入了 Simulus® 柔性瓣环成形术环（美敦力公司，明尼苏达州明尼阿波利斯，美国）。使用声波测量法评估二尖瓣环动力学，使用超声心动图描述瓣叶几何形状。

结果

瓣环成形术环减小了二尖瓣环尺寸并限制了二尖瓣环面积（126 ± 19 对 30 ± 13 mm ²，p < 0.001）、间隔-外侧和连合-连合距离的周期性变化。在二尖瓣后叶重建后，环形瓣环成形术可防止二尖瓣环的收缩期扩大。环状鞍形和瓣叶接合长度（8.7 ± 2.3 与 9.7 ± 1.3 毫米，p = 0.221）在环插入前后相当。