|
|
||||||||
Ann Thorac Surg 2007;84:92-101
© 2007 The Society of Thoracic Surgeons
a Politecnico di Milano, Bioengineering Department, Milan, Italy
b Cardiac Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
c University of Michigan Hospital, Ann Arbor, Michigan
d Politecnico di Torino, Mechanics Department, Torino, Italy
Accepted for publication March 5, 2007.
* Address correspondence to Dr Votta, Dipartimento di Bioingegneria, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, 20133, Italy (Email: emiliano.votta{at}polimi.it).
Background: Functional mitral regurgitation (FMR) is the inability of mitral leaflets to coapt due to a combination of functional and geometrical factors. Valve competence is commonly restored by undersized annuloplasty, reducing the native annulus anteroposterior dimension. In case of severe FMR, this solution may be inadequate. The use of rings specific for the correction of FMR may lead to better results.
Methods: The performance of the Geoform ring, a recently designed FMR-specific prosthesis, was compared with that of a standard Physio annuloplasty ring. Finite element modeling was used to simulate dilated cordiomyopathy-related FMR and compare, at the systolic peak, the valves pathologic condition with the postoperative scenario corresponding to both devices. Three degrees of the pathology were simulated by progressively displacing papillary muscles apically, up to 5 mm. Three ring sizes were modeled.
Results: Regurgitant area, coaptation length, and stresses acting on valve structures were assessed. When the use of the Geoform was modeled, coaptation length was always longer than 7 mm. In the most unfavorable case, the regurgitant area reduction was 74% with respect to baseline, and leaflets stresses were reduced by 20% when undersizing was simulated. When Physio ring implantation was simulated, coaptation length maximum extent was equal to 4.3 mm, the maximum regurgitant area reduction was equal to 60%, and leaflet stress reduction was observed.
Conclusions: Disease-specific prostheses may allow for restoration of valve competence even for significant degrees of leaflets tethering and avoid the need for aggressive undersizing, thus leading to more durable results.
Related Article
Ann. Thorac. Surg. 2007 84: 101-102.
This article has been cited by other articles:
![]() |
S. Gelsomino, R. Lorusso, S. Caciolli, I. Capecchi, C. Rostagno, M. Chioccioli, G. De Cicco, G. Bille, P. Stefano, and G. F. Gensini Insights on left ventricular and valvular mechanisms of recurrent ischemic mitral regurgitation after restrictive annuloplasty and coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 507 - 518. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. A. Armen, R. Vandse, J. A. Crestanello, S. V. Raman, K. M. Bickle, and N. S. Nathan Mechanisms of valve competency after mitral valve annuloplasty for ischaemic mitral regurgitation using the Geoform ring: insights from three-dimensional echocardiography Eur J Echocardiogr, May 13, 2008; (2008) jen165v1. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Gelsomino, R. Lorusso, I. Capecchi, C. Rostagno, S. Romagnoli, G. Bille, G. De Cicco, C. Tetta, P. Stefano, and G. F. Gensini Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation Ann. Thorac. Surg., April 1, 2008; 85(4): 1319 - 1330. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. W.M. Fedak, P. M. McCarthy, and R. O. Bonow Evolving Concepts and Technologies in Mitral Valve Repair Circulation, February 19, 2008; 117(7): 963 - 974. [Full Text] [PDF] |
||||
![]() |
M. B. Ratcliffe Invited commentary Ann. Thorac. Surg., July 1, 2007; 84(1): 101 - 102. [Full Text] [PDF] |
||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |