Remodeling Annuloplasty Using a Prosthetic Ring Designed for Correcting Type-IIIb Ischemic Mitral Regurgitation

Effects of different annuloplasty ring types on mitral leaflet tenting area during acute myocardial ischemia

“…These amounts of mitral annular S-L reduction are slightly less compared to those reported previously in in vitro measurements and [14] beating ovine, non-ischemic hearts [15]. However, the reduction in tenting area compared to pre-implantation values was considerably smaller than those reported in clinical studies, where the approximate decrease in tenting area included 50–60% after IMR Etlogix ring implantation [5, 16] and 75% in tenting volume after GeoForm implantation [10]. These observed discrepancies are most probably due a greater tethering of the mitral valve before ring implantation in patients with chronic IMR compared to sheep valves during acute IMR.…”

“…We recently demonstrated that, compared to a Carpentier Edwards Physio, the approximate amount of septal-lateral reduction includes 10% and 18% for the Edwards IMR ETLogix as well as 25% and 26% for the Edwards GeoForm in vitro [14] and in the normal beating ovine heart [15], respectively. To date, two clinical studies exist that report the effects of the IMR ETlogix on tenting area [5, 16] and one that shows tenting volume after implantation of the GeoForm [17]. Daimon et al [5] and Filsoufi et al [16] report a reduction in tenting area by ~50% and ~60%, respectively, after the implantation of an IMR ETlogix in 59 and 40 IMR patients, respectively, while Armen et al demonstrate a reduction in tenting volume of ~75% after implantation of the GeoForm in a series of 7 patients with IMR [17].…”

“…To date, two clinical studies exist that report the effects of the IMR ETlogix on tenting area [5, 16] and one that shows tenting volume after implantation of the GeoForm [17]. Daimon et al [5] and Filsoufi et al [16] report a reduction in tenting area by ~50% and ~60%, respectively, after the implantation of an IMR ETlogix in 59 and 40 IMR patients, respectively, while Armen et al demonstrate a reduction in tenting volume of ~75% after implantation of the GeoForm in a series of 7 patients with IMR [17]. However, to date no study exists that compares the effects of the different ring types on mitral valve tenting area in a homogenous patient population.…”

Mid-term echocardiographic results with different rings following restrictive mitral annuloplasty for ischaemic cardiomiopathy☆

“…Therefore, it can be hypothesised that RMA, also with a semi-rigid band (acting as a complete ring, as reported by the manufacturer, because it anchors to the two trigones), may relieve CIMR by reducing the septo-lateral distance, but it cannot completely address CIMR without anterior annular remodelling. Accordingly, a recent report from Mount Sinai has shown annuloplasty with flexible partial bands to be suboptimal for CIMR, because it does not completely remodel the native valve and, in particular, neglects the insertion area of the anterior mitral leaflet, thus not stabilising the native valve during the systolic phase and having a limited impact on antero-posterior annular diameter, which is a critical parameter in CIMR [22]. Our data, therefore, strictly agree with the previously published studies on animal models of CIMR, and represent one of the few reports in the current literature in which semi-rigid bands and complete rings in the setting of CIMR were compared.…”

“…On the other hand, there may be another explanation to these findings. The specific geometrical characteristics of the asymmetric annuloplasty rings employed in our practice include a reduced anteroposterior distance to increase leaflet coaptation, a reduced P2-P3 curvature to compensate for the tethered P3 segment and a dipped P3 region to accommodate its downward displacement [22]. Although these theoretical models of changes in the annular geometry and function are very suggestive, there is poor evidence that they might really reflect the actual individual pathomechanism of every single patient with IMR [25].…”