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Impact Of Complete And Non-complete Semi-rigid Mitral Annuloplasty On Aorto-mitral Interaction
Serdar Akansel, Markus Kofler, Martina Dini, Marian Kukucka, Stephan Jacobs, Volkmar Falk, Jörg Kempfert.
Deutsches Herzzentrum der Charite, Berlin, Germany.
BACKGROUND: The aortic and mitral valves, traditionally considered distinct anatomical structures, are interconnected through fibrous tissue and work in a synchronized, reciprocally coupled manner. It is hypothesized that interventions on one valve would influence the function of the other. Annuloplasty rings are routinely used in mitral valve repair(MVr) to provide a durable repair. This study investigated the effect of complete and non-complete MV annuloplasty rings on aorto-mitral interaction using three-dimensional echocardiography in a propensity-matched cohort undergoing minimally-invasive MVr.
METHODS: Patients undergoing minimally-invasive MVr with Carpentier-Edwards Physio-II or recently introduced PhysioFlex annuloplasty rings (Edwards Lifesciences, Irvine, California, United States) for Carpentier type II MV pathology between March 2016 and July 2024 were retrospectively reviewed. Patients were propensity matched 1:1 based on age, gender, body surface area, implanted ring size, left ventricular ejection fraction, and pathology complexity. Three-dimensional mitral and aortic valve reconstruction models were created with a semi-automated software package. Baseline and postoperative pulsatility capacity of mitral and aortic annulus throughout the cardiac cycle, as well as preservation of pulsatility capacity following ring implantation were analyzed.
RESULTS: Patients in the PhysioFlex group demonstrated greater aortic annular pulsatility capacity compared to those in the Physio-II group (15.67±5.31% vs 7.21±3.36% p<0). MVr with ring annuloplasty in the PhysioFlex and Physio-II groups resulted in smaller mitral annulus (18.02±4.63 cm
2 vs 8.58±1.81 cm
2 p<0.001 and 18.60±3.65 cm
2 vs 8.10±1.50 cm
2 p<0.001, respectively), and a smaller aortic annulus in the Physio-II group (5.87±1.13 cm
2 vs 5.60±0.89 cm
2 p=0.003), while the aortic annulus area was preserved in the PhysioFlex group (6.07±1.27 cm
2 vs 5.94±1.19 cm
2 p=0.094). The PhysioFlex group demonstrated better preservation of pulsatility capacity of the aortic valve compared to Physio-II group (106.80±39.77% vs 46.20±29.51% p<0.001).
CONCLUSIONS: This is the first study to evaluate the effects of complete and non-complete semi-rigid annuloplasty rings on aorto-mitral interaction and annular pulsatility capacity. The PhysioFlex annuloplasty ring resulted in fewer undesirable changes to aortic annular hemodynamics and better preservation of pulsatility capacity in both valves. These findings may affect future annuloplasty ring designs.
Figure 1: Three-dimensional mitral (A) and aortic valve (B) reconstruction to quantitate annular geometry using semi-automated software package. Changes in the diameter along the left ventricular outflow tract (C).
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