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J Thorac Cardiovasc Surg 2001;122:665-673
© 2001 The American Association for Thoracic Surgery
Surgery for Aquired Cardiovascular Disease (ACD) |
From the Department of Cardiovascular and Thoracic Surgerya and Division of Cardiovascular Medicine,b Stanford University School of Medicine, Stanford, Calif, and the Department of Cardiovascular Physiology and Biophysics,c Research Institute of the Palo Alto Medical Foundation, Palo Alto, Calif.
Supported by grants HL-29589 and HL-48837 from the National Heart, Lung, and Blood Institute (NHLBI) and in part by an investigational laboratory grant from St Jude Medical, Inc, St Paul, Minn. Drs Dagum and Green were supported by NHLBI Individual Research Service Awards HL10000-01 and HL-09569, respectively. Dr Timek is a recipient of The Thoracic Surgery Foundation Research Fellowship Award and NHLBI IRSA HL 10452-01. Drs Dagum, Timek, and Green are Carl and Leah McConnell Cardiovascular Surgical Research Fellows.
Presented in part at the Seventy-second American Heart Association Annual Scientific Sessions, Atlanta, Ga, November 1999.
Received for publication Jan 19, 2001. Revisions requested March 5, 2001; revisions received April 4, 2001. Accepted for publication April 6, 2001. Address for reprints: D. Craig Miller, MD, Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5247 (E-mail: dcm{at}stanford.edu).
Abstract
Background: It has previously been shown in sheep that mitral annular physiologic dynamics during the cardiac cycle are abolished by complete ring annuloplasty, but recent clinical studies suggest that flexible partial ring annuloplasty preserves normal mitral annular dynamics.
Methods: Eight radiopaque markers were sutured equidistantly around the mitral anulus in 3 groups of sheep: no-ring control animals (n = 16); animals with a flexible Tailor partial ring annuloplasty (n = 6; St Jude Medical, Inc, St Paul, Minn); and animals with a flexible Duran ring annuloplasty (n = 7; Medtronic, Inc, Minneapolis, Minn). After 7 to 10 days&' recovery, 3-dimensional marker coordinates were measured by biplane cinefluoroscopy. Mitral annular area and folding (defined as displacement of the mitral anulus from a least-squares plane) and mitral annular septal-lateral and commissure-commissure dimensions were calculated from the 3-dimensional marker coordinates throughout the cardiac cycle every 17 ms.
Results: In the no-ring control group mitral annular area varied from 8.0 ± 0.2 to 7.2 ± 0.2 cm2 (10% ± 2%), and the septal-lateral and commissure-commissure dimensions varied from 27.7 ± 0.4 to 25.9 ± 0.4 mm (7% ± 1%) and from 38.2 ± 0.8 to 36.4 ± 0.8 mm (5% ± 1%), respectively (mean ± standard error of the mean, P < .001 for all comparisons). In the Duran ring annuloplasty and Tailor partial ring annuloplasty groups, the anulus was fixed in size throughout the cardiac cycle (area = 4.8 ± 0.1 and 5.3 ± 0.3 cm2, septal-lateral = 21.8 ± 0.7 and 22.0 ± 0.8 mm, and commissure-commissure = 27.7 ± 0.7 and 31.2 ± 1.7 mm). Mitral annular folding did not differ significantly between the control and Tailor partial ring annuloplasty groups but was dampened in the Duran ring annuloplasty group.
Conclusions: Partial Tailor flexible ring annuloplasty fixed mitral annular area and dimensions throughout the cardiac cycle in sheep; however, it preserved physiologic mitral annular folding dynamics, which might be important in terms of long-term valve function and prevention of left ventricular outflow tract obstruction.
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