The effects of mitral annuloplasty rings on mitral valve complex 3-D geometry during acute left ventricular ischemia

Lai, David; Timek, Tomasz A.; Tibayan, Frederick A.; Green, G. Randall; Daughters, George T.; Liang, David; Ingels, Neil B.; Miller, D. Craig

doi:10.1016/s1010-7940(02)00530-4

Cited by 29 publications

(28 citation statements)

References 20 publications

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“…15 At the same time that we noted a higher incidence in mitral valve procedures in patients with flexible rings placed during their primary mitral valve procedure, more experimental evidence was accumulating about the theoretical benefits of rigid or nonflexible rings in this subgroup of mitral valve patients with heart failure. 16 Further evidence of the importance of aggressively treating MR was shown in a recent study showing increased risk of MR in affecting the development of congestive heart failure and increased mortality in patients post myocardial infarction. 17 Additionally, autopsy, laboratory, and clinical studies began to appear in the literature showing that the anterior mitral valve leaflet trigone distance was not a permanently fixed distance but was in fact quite dynamic and enlarged over time.…”

Section: Discussionmentioning

confidence: 98%

Flexible Versus Nonflexible Mitral Valve Rings for Congestive Heart Failure

2006

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Background-Surgical intervention is playing an increasingly important therapeutic role in congestive heart failure (CHF) patients with ischemia and dilated cardiomyopathy. Their mitral regurgitation (MR) is a result of left ventricular (LV) geometrical distortion. The optimal type of ring for CHF patients with geometric ventricular-based MR is unknown. This study reviewed the results of flexible versus nonflexible complete mitral valve rings in CHF patients with geometric mitral regurgitation. Methods and Results-Using a prospectively maintained database, patients undergoing mitral valve reconstruction (MVR) with either a flexible or nonflexible complete ring were identified on the basis of preoperative ejection fraction (EF) Յ30% and no primary mitral pathology. These 2 groups of CHF patients with severe geometric MR were then compared in terms of recurrent MR requiring reoperation. Between 1992 and 2004, 289 patients with EF Յ30%, received an undersized complete mitral annuloplasty ring as their MVR procedure. Of these, 170 patients had a flexible complete ring. In follow-up, 16 "flexible" patients (9.4%) required a repeat procedure for significant recurrent geometric MR and CHF (10 replacements, 3 re-repairs, 3 transplants). The average time to reoperation was 2.4 years. In contrast, 119 patients with an EF Յ30% received a MVR using an undersized nonflexible complete ring. Only 3 "non-flexible" patients required a repeat operation, MVR (1), and 2 patients required a transplant. The time to reoperation was 4.0 years. A significant difference in reoperation rates, for recurrent MR, between the 2 groups (Pϭ0.012). There were no differences between groups, in terms of age, ring size used, preoperative EF, LV size, MR grade, or New York Heart Association class. Conclusions-Patients

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Section: Discussionmentioning

confidence: 98%

Flexible Versus Nonflexible Mitral Valve Rings for Congestive Heart Failure

2006

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“…The duration of anticoagulation, however, indicated no necessity for protamine administration (Table 1). Common dose recommendations (Roytblatt et al 1998, Timek et al 2002 for heparine during ECC are triple the dose used in our sheep, leading to prolonged duration of anticoagulation and the necessity to administer protamine as an antagonist at the end of surgery. Protamine administration, however, may be associated with pulmonary hypertension and, hence, its avoidance may be beneficial.…”

Section: Laboratory Animals (2005) 39mentioning

confidence: 99%

Prolonged recovery and respiratory depression after fentanyl infusion in a sheep undergoing mitral valve reconstruction

et al. 2005

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SummaryA sheep was anaesthetized for implantation of a novel device (MitroFast s ) to replace the posterior leaflet of the mitral valve. Anaesthetic management included a balanced anaesthetic protocol and consisted of propofol or isoflurane combined with fentanyl infusion (0.15-0.4 mg/kg/min). Deliberate hypothermia during cardiopulmonary bypass was set at 34.5-35.51C. Surgery proceeded uneventfully. Total time of aortic cross-clamping was 35 min and total time on extracorporeal circulation was 60 min. Visual inspection, intracardiac pressure testing and transesophageal echocardiography indicated proper functioning of the device. The anaesthetic period was uneventful, but recovery was prolonged with central nervous and respiratory depression and marked hypoxaemia. Administration of naloxone (1.5 mg/kg, repeated twice at 15-20 min intervals) reversed the central nervous and attenuated the respiratory depressions. An initially low rate of urine production normalized after rewarming and a single intravenous administration of furosemide.

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“…1 Mitral annular dilation, particularly in the septal-lateral (ie, antero-posterior) dimension, is important for the development of acute and chronic IMR. [2][3][4] Ring annuloplasty, the standard surgical treatment for IMR, resolves this annular dilation, but can be associated with residual or recurrent MR in 9% to 29% of patients within 5 years of follow-up. 5,6 Such variable results, combined with an increased understanding that IMR is as much a ventricular as a valvular problem, have prompted the advance of subvalvular adjuncts to ring annuloplasty for IMR.…”

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confidence: 99%