title: The influence of saddle-shaped annuloplasty on leaflet curvature in patients with ischaemic mitral regurgitation.
abstract: OBJECTIVE
  Reports indicate that repair procedures for ischaemic mitral regurgitation (IMR) are less durable than previously thought. Repair failure has been shown to be stress related. Leaflet curvature is the major determinant of valve stress. Theoretical and animal experiments have shown that saddle-shaped annuloplasty optimizes leaflet curvature when compared with standard flat ring annuloplasty. Despite this, the influence of the ring shape on leaflet curvature has not been described in patients with IMR. This study uses real-time three-dimensional echocardiography (rt-3DE) to assess the influence of the ring shape on leaflet curvature.
  
  
  METHODS
  Rt-3DE was performed in 21 patients with IMR after placement of either a flat (n = 10, CE-Physio, Edwards) or saddle-shaped (n = 11, Profile 3D, Medtronic) annuloplasty ring. A combination of commercially available and customized software was used to measure multiple leaflet curvature parameters across all regions of the mitral valve.
  
  
  RESULTS
  Independently of the shape of the annuloplasty ring, all patients were subject to the same degree of annular undersizing. Patients who received saddle-shaped annuloplasty rings had greater leaflet curvature in all six mitral valve leaflet regions (A1 = 0.36 ± 0.10, A2 = 0.53 ± 0.13, A3 = 0.47 ± 0.13, P1 = 0.35 ± 0.23, P2 = 0.53 ± 0.34, P3 = 0.42 ± 0.20 cm(-2)) compared with patients who received flat annuloplasty rings (A1 = 0.16 ± 0.11, A2 = 0.18 ± 0.09, A3 = 0.16 ± 0.11, P1 = 0.20 ± 0.17, P2 = 0.21 ± 0.11, P3 = 0.18 ± 0.13 cm(-2)). These differences were statistically significant in all regions except the P1 region.
  
  
  CONCLUSIONS
  Saddle-shaped annuloplasty rings increase leaflet curvature compared with flat rings in patients with IMR. As a result, saddle-shaped annuloplasty may decrease leaflet stress and potentially increases the durability of the repair in patients with IMR.
authors.affiliation: Glenolden Research Laboratory, Gorman Cardiovascular Research Group,  University of Pennsylvania, Philadelphia,  PA, USA.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Vergnat
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Levack
authors.forename: Arminder S
authors.initials: AS
authors.lastname: Jassar
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.forename: Y Joseph
authors.initials: YJ
authors.lastname: Woo
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D018570:Risk Assessment; D013314:Stress, Mechanical; D013997:Time Factors; D016896:Treatment Outcome