Initial experience of mitral valve repair using the Carpentier-Edwards Physio II annuloplasty ring

Vohra, Hunaid A.; Whistance, Robert N.; Bezuska, Laurynas; Livesey, Steven

doi:10.1016/j.ejcts.2010.10.004

Cited by 16 publications

(11 citation statements)

References 16 publications

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“…To date, there are only a limited number of studies reporting results of MVR with three-dimensional annuloplasty rings. [12][13][14][15][16] The physiologic MVannulus is saddle-shaped, with its highest points located anteriorly and posteriorly in the middle of the respective annulus. Its lowest points are located medially and laterally, below the commissures.…”

Section: Discussionmentioning

confidence: 99%

Is a Profiled Annuloplasty Ring Suitable for Repair of Degenerative Mitral Regurgitation? A Single-Center Experience Comprising 200 Patients

Guenzinger

Guenther

Ratschiller

et al. 2015

Thorac cardiovasc Surg

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Background Various devices have been proposed for ring annuloplasty in patients with degenerative mitral valve disease. This study reports for the first time midterm results with the rigid three-dimensional Medtronic Profile 3D (Medtronic, Minneapolis, Minnesota, United States) annuloplasty ring. Methods Between June 2009 and June 2011, 200 patients (mean age 61 ± 13 years, 70% male) with severe degenerative mitral regurgitation underwent mitral valve repair using the Medtronic Profile 3D annuloplasty ring. A total of 106 patients (53.0%) underwent isolated mitral valve repair and 94 patients (47.0%) underwent a concomitant procedure such as coronary artery bypass grafting (n = 21), tricuspid valve surgery (n = 49), AF ablation (n = 17), and aortic valve surgery (n = 13). The follow-up is 94.5% complete (mean 2.5 ± 0.5 years). Results Thirty-day mortality was 1.5%. Survival at 3 years was 97.1 ± 1.6% for isolated procedures and 92.4 ± 2.8% for combined procedures (p = 0.137). Freedom from mitral valve-related reoperation at 3 years was 97.1 ± 1.7% for isolated procedures and 95.5 ± 2.2% for combined procedures (p = 0.561). Seven patients (3.5%) required a mitral valve-related reoperation. Two of these reoperations were required for endocarditis, two for ring dehiscence, one for progression of the native disease (flail leaflet), one for leaflet suture dehiscence, and one for persistent systolic anterior motion. Conclusion The three-dimensional Medtronic Profile 3D annuloplasty ring is suitable for mitral valve repair for degenerative diseases. This saddle-shaped annuloplasty device provides excellent early results with a very good functional outcome at midterm either in isolated or combined procedures.

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Section: Discussionmentioning

confidence: 99%

Is a Profiled Annuloplasty Ring Suitable for Repair of Degenerative Mitral Regurgitation? A Single-Center Experience Comprising 200 Patients

Guenzinger

Guenther

Ratschiller

et al. 2015

Thorac cardiovasc Surg

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“…From a perspective of leaflet coaptation, saddle‐shaped ring annuloplasty allows a more preferred morphologic and functional leaflet coaptation, including coaptation angle, coaptation area, and coaptation tenting height during systole compared with flat ring annuloplasty involving immobilization of the posterior leaflet . The Physio II ring, one of the most popular annuloplasty rings to date, has a D shape with the anterior region of the ring structure being nearly straight and the posterior portion has a curvature to restore the original shape of the mitral annulus . By contrast, the GeoForm ring was designed to elevate midposterior annulus toward the anterior direction to effectively reduce the anterior‐posterior distance and minimize reduction of the annular surface area .…”

Section: Discussionmentioning

confidence: 99%

“…31 The Physio II ring, one of the most popular annuloplasty rings to date, has a D shape with the anterior region of the ring structure being nearly straight and the posterior portion has a curvature to restore the original shape of the mitral annulus. [32][33][34] By contrast, the GeoForm ring was designed to elevate midposterior annulus toward the anterior direction to effectively reduce the anterior-posterior distance and minimize reduction of the annular surface area. 14,35 The GeoForm ring is generally used for the treatment of functional MR induced by both ischemic and nonischemic dilated cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

Computational virtual evaluation of the effect of annuloplasty ring shape

Choi

McPherson

Kim

2016

Numer Methods Biomed Eng

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Mitral regurgitation (MR) is a result of mitral valve (MV) pathology. Its etiology can be categorized as degenerative or functional MR. Ring annuloplasty aims to reconfigure a dilated mitral annulus to its normal size and shape. We investigated the effect of annuloplasty ring shape on MR outcome using our established 3D echocardiography-based computational MV evaluation protocols. Virtual patient MV models were created from 3D transesophageal echocardiographic data in patients with MR due to mitral annular dilation. Two distinct annuloplasty rings (Physio II and GeoForm) were designed and virtually implanted to the patient MVs. Dynamic FE simulations of MV function were performed for each MV following virtual ring annuloplasty of either ring, and physiologic and biomechanical characteristics of MV function were compared. Excessive stress values appeared primarily in the mid-anterior and mid-posterior regions, and lack of leaflet coaptation was found in pre-annuloplasty patient MVs. Both rings demonstrated marked reduction of stresses and efficient leaflet coaptation. The Physio II ring demonstrated more evenly distributed stress reduction across the leaflets and annulus compared to the GeoForm ring. Conversely, the highly non-planar curvature of the GeoForm ring more effectively increased leaflet coaptation compared to the Physio II ring. This indicates that the shape of annuloplasty ring affects post-annuloplasty physiologic and biomechanical conditions, which can lead to tissue alteration over a longer period of time following ring annuloplasty. This virtual ring annuloplasty simulation strategy provides detailed physiologic and biomechanical information and may help better plan the optimal ring selection and improved patient-specific MV repairs.

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“…This more circular shape may also have the added benefit of reducing the incidence of systolic anterior motion after repair. Unlike the CG Future rings, this ring demonstrates rigidity at the anterior portion to contrast with the flexibility of its posterior aspect [17]. This differential flexibility was theorized to not only reduce stress on the sutures but also maintain the annulus remodeling effect.…”

Section: Methodsmentioning

confidence: 99%

In-Vivo Analysis of Selectively Flexible Mitral Annuloplasty Rings Using Three-Dimensional Echocardiography

Owais

Kim

Khabbaz

et al. 2014

The Annals of Thoracic Surgery

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Initial experience of mitral valve repair using the Carpentier-Edwards Physio II annuloplasty ring

Abstract: MV repair with the Physio II ring has excellent short-term results, including subgroups with large anterior mitral valve leaflet (AMVL). Moreover, the dimensional ratios of the ring may allow it to be used for MV repair for degenerative MV disease, irrespective of anterior leaflet size.

Cited by 16 publications

References 16 publications

Is a Profiled Annuloplasty Ring Suitable for Repair of Degenerative Mitral Regurgitation? A Single-Center Experience Comprising 200 Patients

Is a Profiled Annuloplasty Ring Suitable for Repair of Degenerative Mitral Regurgitation? A Single-Center Experience Comprising 200 Patients

Computational virtual evaluation of the effect of annuloplasty ring shape

In-Vivo Analysis of Selectively Flexible Mitral Annuloplasty Rings Using Three-Dimensional Echocardiography

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