title: Is physiologic annular dynamics preserved after mitral valve repair with rigid or semirigid ring?
abstract: BACKGROUND
  Various rings are available to achieve more physiologic mitral valve repair from viewpoints of physiologic mitral annular structure or dynamics. We evaluated preoperative and postoperative mitral annular structures and dynamics.
  
  
  METHODS
  Thirty-six patients underwent mitral valve repair for degenerative mitral insufficiency. Carpentier-Edwards Physio II ring (semirigid [Edwards Lifesciences, Irvine, CA]), St. Jude Medical Rigid Saddle Ring (RSR [St. Jude Medical, St. Paul, MN]), and MEMO 3D ring (semirigid [Sorin SpA, Milan, Italy]) were implanted in 13, 12, and 11 patients, respectively. Intraoperative real-time three-dimensional transesophageal echocardiography was performed before and after repair.
  
  
  RESULTS
  The postoperative anteroposterior diameter reduction rate from end diastole to end systole was significantly (p<0.0001) larger in MEMO (9.58%±2.91%) than in Physio II (0.98%±1.04%) and RSR (1.94%±1.95%). There were no significant differences in the commissure-to-commissure diameter reduction rates among the groups: 0.81%±1.98% for Physio II, 0.12%±0.53% for RSR, and 0.51%±1.98% for MEMO. The postoperative end-systolic annular height commissure width ratio was significantly (p<0.0001) larger in both Physio II (17.9%±3.0%) and RSR (18.5%±1.6%) than in MEMO (13.6%±3.0%). The postoperative annular height commissure width ratio increase rate from end diastole to end systole was significantly larger in MEMO (5.1%±2.3%) than in Physio II (0.1%±0.6%) and RSR (0.3%±0.5%).
  
  
  CONCLUSIONS
  Physio II and RSR could restore the physiologic three-dimensional annular shape, but the annular motion was diminished. Conversely, MEMO could preserve both the anteroposterior movement and folding dynamics, but no three-dimensional restoration of the mitral annulus was obtained.
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ryomoto
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Mitsuno
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yamamura
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Hiroe
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Fukui
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Tsujiya
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kajiyama
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: y-miyamo@hyo-med.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyamoto
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011446:Prospective Studies; D019736:Prostheses and Implants; D011474:Prosthesis Design
keywords: 35