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Original Articles: Adult Cardiac

Saddle-Shape Annuloplasty Increases Mitral Leaflet Coaptation After Repair for Flail Posterior Leaflet

^a Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
^b Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
^c Department of Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania
^d Department of Biostatistics & Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
^e Department of Pediatrics University of Pennsylvania, Philadelphia, Pennsylvania

Accepted for publication April 7, 2011.

^_* Address correspondence to Dr Joseph H. Gorman III, Gorman Cardiovascular Research Group, Glenolden Research Laboratory, University of Pennsylvania, 500 S Ridgeway Ave, Glenolden, PA 19036 (Email: gormanj{at}uphs.upenn.edu).

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.

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Invited Commentary

Amedeo Anselmi
Ann. Thorac. Surg. 2011 92: 803-804. [Extract] [Full Text] [PDF]

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