• J. Thorac. Cardiovasc. Surg. · Oct 2014

    Comparative Study

    Mitral valve annuloplasty and anterior leaflet augmentation for functional ischemic mitral regurgitation: quantitative comparison of coaptation and subvalvular tethering.

    • Jean-Pierre M Rabbah, Andrew W Siefert, Steven F Bolling, and Ajit P Yoganathan.
    • Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga.
    • J. Thorac. Cardiovasc. Surg. 2014 Oct 1; 148 (4): 1688-93.

    ObjectiveAlthough restrictive mitral annuloplasty (RMA) has been the preferred surgical treatment of functional ischemic mitral regurgitation (FIMR), some patients with severely dilated left ventricles will experience recurrent mitral regurgitation (MR). Consequently, new surgical strategies have been entertained to compensate for severely dilated ventricles by maximizing coaptation and reducing subvalvular tethering. Anterior leaflet augmentation (ALA) with mitral annuloplasty has been theorized to meet these goals. We compared the mechanistic effects of RMA and adjunct ALA in the setting of FIMR.MethodsMitral valves were mounted in a clinically relevant left heart simulator. The tested conditions included control, FIMR, RMA, and true-size annuloplasty with either a small or large ALA. The A2-P2 leaflet coaptation length, MR, and strut and intermediary chordal forces were quantified. All repairs alleviated the MR. The coaptation length was significantly increased from FIMR to RMA, small ALA, and large ALA (P<.001). Between repairs, a large ALA created the greatest length of coaptation (P<.05). Tethering forces from the posteromedial strut chordae were reduced from the FIMR condition by all repairs (P<.001). Only a large ALA reduced the intermediate chordal tethering from the FIMR condition (P<.05).ConclusionsA large ALA procedure created the greatest coaptation and reduced chordal tethering. Although all repairs abolished MR acutely, the repairs that create the greatest coaptation might conceivably produce a more robust and lasting repair in the chronic stage. A clinical need still exists to best identify which patients with altered mitral valve geometries would most benefit from an adjunct procedure or RMA alone.Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…