Bouchez Stefaan, Timmermans Frank, Philipsen Tine, François Katrien, Bové Thierry
Department of Cardiac Anesthesiology, University Hospital of Gent, Gent, Belgium.
Department of Cardiology, University Hospital of Gent, Gent, Belgium.
Eur J Cardiothorac Surg. 2019 Feb 15. doi: 10.1093/ejcts/ezz035.
The choice of annuloplasty device is fundamental at the time of mitral valve repair, the goal being to optimally restore the physiological 3-dimensional (3D) structure and dynamics of the mitral annulus (MA). This study evaluated MA dynamics after annuloplasty with 2 different semi-rigid devices.
Thirty-three patients eligible for mitral valve repair were selected for annuloplasty with the Physio II ring (Edwards Lifesciences, Irving, CA, USA) (n = 17) or the Memo 3D ring (LivaNova, Saluggia, Italy) (n = 16). MA dynamics were assessed with transoesophageal 3D echocardiography intraoperatively and 1 year after repair.
The postoperative changes in the anteroposterior diameter {3.7% [standard deviation (SD) 2.7] vs 1.9% [SD 1.3]; P = 0.013} and in the annular height [27.7% (SD 8.7) vs 18.0% (SD 13.9); P = 0.003] were significantly larger with the Memo 3D ring during the cardiac cycle. The restoration of the saddle shape at baseline was superior with the Physio II ring, defined by a larger systolic annular height-to-commissural width ratio [15.1% (SD 2.3) vs 7.1% (SD 2.4); P < 0.001]. These observations of MA dynamics were sustained after 1 year, shown by a greater anteroposterior extension [5.1% (SD 1.0) vs 1.7% (SD 1.6); P = 0.002] and change in annular height-to-commissural width ratio [15.7% (SD 12.7) vs 3.1% (SD 3.0); P = 0.020] for the Memo 3D ring. There were no significant differences in mitral valve function between the 2 devices.
The MA dynamics after annuloplasty with the Physio II and Memo 3D rings demonstrated a better systolic 3D restoration of the saddle shape with the Physio II ring, whereas the saddle-shaped geometry improved significantly with the Memo 3D ring, as a dynamic phenomenon. The Memo 3D ring also showed increased anteroposterior annular mobility and folding dynamics throughout the cardiac cycle. Moreover, the observed differences in MA dynamics between both devices appeared to be sustainable 1 year after ring implantation.
在二尖瓣修复时，瓣环成形装置的选择至关重要，目标是最佳地恢复二尖瓣环（MA）的生理三维（3D）结构和动力学。本研究评估了使用两种不同半刚性装置进行瓣环成形术后的MA动力学。
选择33例适合二尖瓣修复的患者进行瓣环成形术，其中17例使用Physio II环（美国爱德华生命科学公司，欧文，加利福尼亚州），16例使用Memo 3D环（意大利LivaNova公司，萨卢贾）。术中及修复后1年使用经食管三维超声心动图评估MA动力学。
在心动周期中，Memo 3D环术后前后径的变化[3.7%（标准差[SD]2.7）对1.9%（SD 1.3）；P = 0.013]和瓣环高度的变化[27.7%（SD 8.7）对18.0%（SD 13.9）；P = 0.003]明显更大。Physio II环在基线时鞍形的恢复更好，由收缩期瓣环高度与连合宽度之比更大来定义[15.1%（SD 2.3）对7.1%（SD 2.4）；P < 0.001]。这些MA动力学观察结果在1年后仍然存在，Memo 3D环的前后延伸更大[5.1%（SD 1.0）对1.7%（SD 1.6）；P = 0.002]，瓣环高度与连合宽度之比的变化更大[15.7%（SD 12.7）对3.1%（SD 3.0）；P = 0.020]。两种装置之间二尖瓣功能无显著差异。
使用Physio II环和Memo 3D环进行瓣环成形术后的MA动力学显示，Physio II环在收缩期对鞍形的三维恢复更好，而Memo 3D环作为一种动态现象，鞍形几何形状有显著改善。Memo 3D环在整个心动周期中还显示出前后瓣环活动度和折叠动力学增加。此外，两种装置之间观察到的MA动力学差异在环植入1年后似乎仍然存在。
