The effect of different mitral annuloplasty rings on valve geometry and annular stress distribution†

Skov, Søren Nielsen; Røpcke, Diana Mathilde; Tjørnild, Marcell Juan; Ilkjær, Christine; Rasmussen, Jørgen Gulddahl; Nygaard, Hans; Jensen, Morten Ø.; Nielsen, Sten Lyager

doi:10.1093/icvts/ivx004

Cited by 20 publications

(28 citation statements)

References 20 publications

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“…Short- and long-term outcomes of mitral annuloplasty ring repair with flexible and rigid rings have been found to be often comparable in terms of long-term survival, mortality, reoperation and recurrence of regurgitation [ 42 , 43 ]. Nevertheless, preclinical and clinical studies postulated rigid annuloplasty rings to result in higher rates of dehiscence both for the mitral and tricuspid valve [ 13 , 33 , 44 ]. By being a dynamic structure, the valve annulus plays an active role in the function of the valve system, with the superficial sinospiral-bulbospiral muscles and deep sinospiral muscles contracting and relaxing.…”

Section: Discussionmentioning

confidence: 99%

“…Flexible rings have been used to reduce the annular size, they are designed to allow for the physiological motion of the valve annulus to take place during the cardiac cycle, thus improving annular stress distribution and reducing the risk of ring dehiscence [ 45 , 46 ]. Oppositely, rigid rings allow for sizing and shaping of the mitral annulus thus restricting its motion during the cardiac cycle and worsening annular stress distribution, thus contributing to a higher risk of dehiscence [ 44–47 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our results also indicated lower dehiscence rates with semi-rigid when compared to rigid rings in mitral position. The difference has been explained in in vitro and in vivo studies based on the location of dehiscence occurrence [ 44 ]. Indeed, mitral ring dehiscence was found to be mostly located in the posterior segment of the mitral annulus, due to the segment being constituted of low-collagen muscular fibres, thus increasing the risk of dehiscence [ 13 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

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Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

Rad

Naruka

Vardanyan

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and predisposing risk factors for annuloplasty ring dehiscence include technical and pathological ones. METHODS A systematic database search with pooled analysis was conducted of original articles that only included dehiscence rate of mitral and tricuspid ring in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to November 2020. The outcomes included were dehiscence rate in mitral and tricuspid, type of ring implanted, dehiscence rate by pathology and by ring size and shape. RESULTS Our search yielded 821 relevant studies. Thirty-three studies met the inclusion criteria with a total of 10 340 patients (6543 mitral, 1414 tricuspid) of which 87 (mitral) and 30 (tricuspid) had dehiscence. Overall, dehiscence rate was 1.43%, diagnosed at a median of 4.5 ± 1.0 months postoperatively. A significant difference in mitral dehiscence rate was found by ring type (semi-rigid 1.86%, rigid 2.32%; flexible 0.43%; P < 0.001). There was no significant difference in rate of dehiscence by ring size (P = 0.067) and shape in mitral (P = 0.281) but there was higher dehiscence rate in ischaemic compared to non-ischaemic mitral regurgitation (3.91% vs 1.63%; P = 0.022). Among tricuspid studies, 9 of 10 studies did not report any dehiscence. CONCLUSIONS Although rigid, semi-rigid and flexible annuloplasty rings provide acceptable valve repair outcomes, mitral annuloplasty ring dehiscence is clinically more common among rigid rings. Understanding the multifactorial nature of ring dehiscence will help in identifying the patients at high risk and improve their clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

Rad

Naruka

Vardanyan

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…Furthermore, this fixation of the MV’s annular movements increases significantly the stress on ring sutures and on the mitral chords increasing the risk for ring dehiscence and mitral chord failure/rupture [9,10,11]. Although the rigid incomplete ring designs provide no fixation of the aorto-mitral membrane, they too interfere with the hinge-saddle motion of the posterior portion of the MV annulus.…”

Section: Discussionmentioning

confidence: 99%

The Impact of a New “Inverted Arch” Prosthetic Annuloplasty Ring on the Mitral Valve’s 3-D Motion: An Experimental Ex-Vivo Study

Caimmi¹,

Kapetanakis

Beggino

et al. 2019

Bioengineering

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This experimental study aimed to evaluate the ex-vivo three-dimensional (3-D) motion of the Inverted Arch Ring (IAR), an innovative new design concept for a flexible incomplete annuloplasty prosthesis with an incorporated stabilizing rigid arch that can be used in correcting mitral valve regurgitation. Twenty explanted porcine hearts were placed in a circulation simulation system. Ultrasonometry transducers implanted in the mitral annulus were used to measure the 3-D valvular motion during a simulated cardiac cycle. Annular distance measurements were recorded and compared in each heart before and after the implantation of the IAR prosthesis at pressures corresponding to mid-systole and mid-diastole. Distances measured in mid-systole and mid-diastole demonstrated no significant differences in annular motion or in valve areas either prior to or after IAR implantation. Therefore, the results of this study confirm the minimal effects exerted by the IAR prosthesis on the mitral valve’s 3-D motion during a simulated cardiac cycle.

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“…The acquisition after iodine injection and cardiac rhythm synchronization shows a calcified mass embedded in the ventricular myocardium. In addition, CT scan is used to look for sequelae of an old chest trauma: costal fractures, pericardial calcifications, lung lesions [10][11][12][13].…”

Section: Journal Ofmentioning

confidence: 99%

Convulsive Seizures Revealing-A Caseous Calcification of the Mitral Annulus (CCMA): A Case Report

Js¹,

Zabalawi²,

Plurien³

et al. 2017

J Clin Exp Cardiolog

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Caseous necrosis of the mitral valve ring is a process that is all the more frequently encountered as life expectancy is increased, often by accidental discovery, and is considered as a benign condition, with the responsibility for the clinical symptoms leading to its discovery remains difficult. Through this clinical case, we rediscover the clinical polymorphism of this pathology, the diagnosis of which has been confirmed by the CT scan.

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The effect of different mitral annuloplasty rings on valve geometry and annular stress distribution†

Cited by 20 publications

References 20 publications

Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

The Impact of a New “Inverted Arch” Prosthetic Annuloplasty Ring on the Mitral Valve’s 3-D Motion: An Experimental Ex-Vivo Study

Convulsive Seizures Revealing-A Caseous Calcification of the Mitral Annulus (CCMA): A Case Report

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