Takahashi Yosuke, Morisaki Akimasa, Sakon Yoshito, Nishiya Kenta, Inno Goki, Kawase Takumi, Nishimoto Yukihiro, Nagao Munehide, Kishimoto Noriaki, Noda Kazuki, Shibata Toshihiko
Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan.
Front Cardiovasc Med. 2024 Sep 11;11:1369801. doi: 10.3389/fcvm.2024.1369801. eCollection 2024.
This study aimed to evaluate the efficacy of preoperative computed tomography in assessing mitral annulus anatomy and the posterior annular plication rate in mitral valve repair with annuloplasty.
From July 2018 to August 2023, we performed robotic mitral valve repair with ring annuloplasty using a semi-rigid ring in 100 patients. Preoperative anatomical assessment of the mitral annulus was conducted by three-dimensional computed tomography. The ring size was selected based on the perioperative commissure-to-commissure length or the anterior leaflet area.
The mean commissure-to-commissure length, posterior mitral annular length, and minimum distance between the left circumflex artery and mitral annulus values were 31, 109, and 3.8 mm, respectively. No postoperative left circumflex artery injury or ring detachment was recorded. The mean plication rate (length of the posterior side of the prosthetic ring/posterior annular length) was 0.68, and it did not differ among each prosthetic ring size. The posterior plication rate (duplicate ring size 19.4) was a factor influencing the postoperative transmitral mean pressure gradient of 5 mmHg or higher. Freedom from moderate or severe mitral regurgitation was not different between the two groups above and below the posterior plication rate × ring size of 19.4 ( = 0.73), with an event-free rate of 97% vs. 96% in 3 years, respectively.
Preoperative evaluation of the mitral annular anatomy is useful for safe mitral valve repair with ring annuloplasty. Determining ring size by focusing on the posterior annular plication rate may be a new method for ring size selection.
本研究旨在评估术前计算机断层扫描在评估二尖瓣环解剖结构以及二尖瓣成形术修复二尖瓣时后瓣环折叠率方面的有效性。
2018年7月至2023年8月，我们对100例患者采用半刚性环行机器人二尖瓣成形术。通过三维计算机断层扫描对二尖瓣环进行术前解剖评估。根据围手术期瓣叶交界至瓣叶交界长度或前叶面积选择环的大小。
瓣叶交界至瓣叶交界平均长度、二尖瓣后瓣环长度以及左旋支动脉与二尖瓣环之间的最小距离值分别为31mm、109mm和3.8mm。未记录到术后左旋支动脉损伤或环脱离。平均折叠率（人工环后侧长度/后瓣环长度）为0.68，各人工环大小之间无差异。后折叠率（重复环大小19.4）是影响术后二尖瓣平均压力阶差≥5mmHg的一个因素。后折叠率×环大小19.4以上和以下两组之间，无中度或重度二尖瓣反流的自由度无差异（=0.73），3年无事件发生率分别为97%和96%。
二尖瓣环解剖结构的术前评估有助于安全地进行环行二尖瓣成形术。通过关注后瓣环折叠率来确定环的大小可能是一种新的环大小选择方法。
