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Original Articles: Adult Cardiac

The Influence of Annuloplasty Ring Geometry on Mitral Leaflet Curvature

^a The Harrison Department of Surgical Research, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
^b Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Accepted for publication March 31, 2008.

^_* Address correspondence to Dr Robert C. Gorman, Department of Surgery, 313 Stemmler Hall, 36th and Hamilton Walk, University of Pennsylvania, Philadelphia, PA 19104-4283 (Email: gormanr{at}uphs.upenn.edu).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: The effect of mitral leaflet curvature on stress reduction is an important mechanism in optimizing valve function. We hypothesize that annuloplasty ring shape could directly influence leaflet curvature and, potentially, repair durability. We describe an echocardiographically based methodology for quantifying mitral valve geometry and its application to the characterization of ovine mitral valve geometry before and after implantation of an annuloplasty ring.

Methods: Multiple mitral annular and leaflet geometric variables were calculated for 8 naïve adult male sheep using real-time three-dimensional echocardiographic images. These indexes were recalculated after annuloplasty using a 30-mm Carpentier-Edward Physio ring (n = 4; Edwards Lifesciences, Irvine, CA) or a 30-mm saddle ring (n = 4).

Results: After implantation of the Physio ring, the annular height to commissural width ratio (AHCWR) decreased from 19.4% ± 2.3% to 11.1% ± 2.5% (p = 0.06). After implantation of the saddle ring, AHCWR increased from 19.6% ± 1.3% to 24.3% ± 1.3% (p < 0.05). Statistically significant increases in three-dimensional Gaussian curvature occurred after implantation within six defined leaflet regions (A1 to A3, P1 to P3) of the saddle ring but only within the P1 and P3 leaflet regions with the Physio ring.

Conclusions: Annuloplasty ring shape affects leaflet curvature. Implantation of a saddle ring reflecting normal human annular geometry augmented ovine annular nonplanarity and increased three-dimensional leaflet curvature across the entire mitral valve surface. The Physio ring decreased annular nonplanarity and increased leaflet curvature only across limited regions of the posterior leaflet. These findings confirm the hypothesis that ring design influences leaflet curvature.

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