Bothe Wolfgang, Swanson Julia C, Ingels Neil B, Miller D Craig
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif. 94305-5247, USA.
J Thorac Cardiovasc Surg. 2010 Jul;140(1):117-21, 121.e1-3. doi: 10.1016/j.jtcvs.2009.10.033. Epub 2010 Jan 13.
Disproportionate reduction of the mitral septal-lateral annular dimension is the goal in the surgical treatment of ischemic or functional mitral regurgitation and avoids the need for ring "downsizing." How much the new annuloplasty rings designed for patients with ischemic/functional mitral regurgitation reduce annular septal-lateral dimension, however, is proprietary information and debated.
Outer and inner septal-lateral and commissure-commissure diameters of all available sizes of Edwards GeoForm, Edwards IMR ETlogix (both Edwards Lifesciences, Irvine, Calif), St Jude Medical Rigid Saddle Annuloplasty Ring (St Jude Medical, Inc, St Paul, Minn), and Medtronic Profile 3D (Medtronic, Minneapolis, Minn) annuloplasty rings with and without the fabric covering were measured with electronic calipers. These rings were compared with a Carpentier-Edwards Physio ring (Edwards Lifesciences) to assess the relative amount of septal-lateral and commissure-commissure dimension change. Average fractional changes (% +/-1 standard deviation) versus the Physio ring were calculated.
The GeoForm provided the greatest outer septal-lateral reduction relative to Physio ring (-24% +/- 2%), followed by the IMR ETlogix (-9% +/- 2%) and Profile 3D (-8% +/- 5%). The septal-lateral diameter of the Rigid Saddle Annuloplasty Ring was similar to that of the Physio ring (+1% +/- 3%). Although commissure-commissure outer diameters of the IMR ETlogix, Rigid Saddle Annuloplasty Ring, and Profile 3D were similar to that of the Physio ring (0% +/- 2%, +4% +/- 3%, and +3% +/- 4%, respectively), the GeoForm had a larger commissure-commissure dimension (+12% +/- 2%). The inner diameter septal-lateral reductions were even more pronounced.
Relative to the Physio ring, the GeoForm has the most outer and inner septal-lateral reduction but larger commissure-commissure dimension; the IMR ETlogix and Profile 3D provide a moderate degree of septal-lateral reduction without affecting commissure-commissure dimension, and Rigid Saddle Annuloplasty Ring septal-lateral and commissure-commissure diameters are similar to those of the Physio ring. Knowing the degree of disproportionate septal-lateral downsizing inherent in each ring type will help guide surgical decision making.
二尖瓣间隔 - 外侧环尺寸的不均衡缩小是缺血性或功能性二尖瓣反流外科治疗的目标，可避免使用尺寸更小的环。然而，专为缺血性/功能性二尖瓣反流患者设计的新型瓣环成形环能使间隔 - 外侧环尺寸缩小多少属于专利信息且存在争议。
使用电子卡尺测量了所有可用尺寸的爱德华兹GeoForm环、爱德华兹IMR ETlogix环（均为爱德华兹生命科学公司，加利福尼亚州欧文市）、圣犹达医疗刚性鞍形瓣环成形环（圣犹达医疗公司，明尼苏达州圣保罗市）和美敦力Profile 3D环（美敦力公司，明尼阿波利斯市）有无织物覆盖时的外侧和内侧间隔 - 外侧以及瓣叶连合 - 瓣叶连合直径。将这些环与卡彭蒂埃 - 爱德华兹生理环（爱德华兹生命科学公司）进行比较，以评估间隔 - 外侧和瓣叶连合 - 瓣叶连合尺寸变化的相对程度。计算相对于生理环的平均分数变化（%±1标准差）。
相对于生理环，GeoForm环的外侧间隔 - 外侧缩小程度最大（-24%±2%），其次是IMR ETlogix环（-9%±2%）和Profile 3D环（-8%±5%）。刚性鞍形瓣环成形环的间隔 - 外侧直径与生理环相似（+1%±3%）。虽然IMR ETlogix环、刚性鞍形瓣环成形环和Profile 3D环的瓣叶连合 - 瓣叶连合外径与生理环相似（分别为0%±2%、+4%±3%和+3%±4%），但GeoForm环的瓣叶连合 - 瓣叶连合尺寸更大（+12%±2%）。内侧直径的间隔 - 外侧缩小更为明显。
相对于生理环，GeoForm环的外侧和内侧间隔 - 外侧缩小最多，但瓣叶连合 - 瓣叶连合尺寸更大；IMR ETlogix环和Profile 3D环提供适度的间隔 - 外侧缩小，且不影响瓣叶连合 - 瓣叶连合尺寸，刚性鞍形瓣环成形环的间隔 - 外侧和瓣叶连合 - 瓣叶连合直径与生理环相似。了解每种环类型固有的间隔 - 外侧不均衡缩小程度将有助于指导手术决策。
