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Edge-to-edge mitral repair: tension on the approximating suture and leaflet deformation during acute ischemic mitral regurgitation in the ovine heart
Edge-to-edge approximation of the mitral valve leaflets (Alfieri procedure) is a novel surgical treatment for patients with ischemic mitral regurgitation (IMR). Long-term durability may be limited if abnormal mitral leaflet stresses result from this procedure. The aim of the current study was to mea...
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| Published in: | Circulation (New York, N.Y.) N.Y.), 2001-09, Vol.104 (12 Suppl 1), p.I29-I35 |
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| container_end_page | I35 |
| container_issue | 12 Suppl 1 |
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| container_title | Circulation (New York, N.Y.) |
| container_volume | 104 |
| creator | Nielsen, S L Timek, T A Lai, D T Daughters, G T Liang, D Hasenkam, J M Ingels, N B Miller, D C |
| description | Edge-to-edge approximation of the mitral valve leaflets (Alfieri procedure) is a novel surgical treatment for patients with ischemic mitral regurgitation (IMR). Long-term durability may be limited if abnormal mitral leaflet stresses result from this procedure. The aim of the current study was to measure Alfieri stitch tension (F(A)) and to explore its geometric determinants in an ovine model of acute IMR as a reflection of the mitral leaflet stresses imposed by the procedure.
Eight sheep were studied immediately after surgical placement of (1) a force transducer interposed between sutures approximating the central leaflet edges and (2) radiopaque markers around the mitral annulus and leaflet edges. Computer-aided analysis of videofluorograms was used to obtained 3D marker coordinates. Simultaneous measurements of F(A), septal-lateral annular dimension (L(S-L)), leaflet edge separation (L(SEP)), anterior (L(AL)) and posterior (L(PL)) leaflet length, and hemodynamic variables were obtained at baseline (CTL) and during acute IMR (circumflex artery occlusion). F(A) was significantly elevated throughout the cardiac cycle during IMR compared with CTL, with maximum F(A) in diastole (0.26+/-0.05 versus 0.46+/-0.08 N, CTL versus IMR; P |
| doi_str_mv | 10.1161/circ.104.suppl_1.I-29 |
| format | article |
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Eight sheep were studied immediately after surgical placement of (1) a force transducer interposed between sutures approximating the central leaflet edges and (2) radiopaque markers around the mitral annulus and leaflet edges. Computer-aided analysis of videofluorograms was used to obtained 3D marker coordinates. Simultaneous measurements of F(A), septal-lateral annular dimension (L(S-L)), leaflet edge separation (L(SEP)), anterior (L(AL)) and posterior (L(PL)) leaflet length, and hemodynamic variables were obtained at baseline (CTL) and during acute IMR (circumflex artery occlusion). F(A) was significantly elevated throughout the cardiac cycle during IMR compared with CTL, with maximum F(A) in diastole (0.26+/-0.05 versus 0.46+/-0.08 N, CTL versus IMR; P<0.05). Multivariable analysis revealed L(S-L) as the single independent predictor of maximum F(A) (P<0.001). Positive linear correlations were shown between values of F(A) and L(AL) and L(PL) (dependent variables).
These experimental data demonstrate higher F(A) during IMR and cyclic changes in F(A) closely paralleling changes in L(S-L), eg, being greatest in diastole when the annulus is largest. Increased F(A) during IMR is probably indicative of successful therapeutic intent, but higher diastolic leaflet stresses resulting from persistent or progressive mitral annular dilatation may adversely affect repair durability. This indirectly implies that concomitant mitral ring annuloplasty should be added to the Alfieri repair.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/circ.104.suppl_1.I-29</identifier><identifier>PMID: 11568026</identifier><language>eng</language><publisher>United States</publisher><subject>Acute Disease ; Animals ; Cardiac Surgical Procedures ; Diastole ; Disease Models, Animal ; Echocardiography, Doppler ; Echocardiography, Doppler, Color ; Fluoroscopy - methods ; Hemodynamics ; Mitral Valve - diagnostic imaging ; Mitral Valve - physiopathology ; Mitral Valve - surgery ; Mitral Valve Insufficiency - complications ; Mitral Valve Insufficiency - diagnosis ; Mitral Valve Insufficiency - physiopathology ; Mitral Valve Insufficiency - surgery ; Multivariate Analysis ; Myocardial Ischemia - complications ; Sheep ; Stress, Mechanical ; Suture Techniques ; Systole</subject><ispartof>Circulation (New York, N.Y.), 2001-09, Vol.104 (12 Suppl 1), p.I29-I35</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c253t-a75146272557d01f5862b942a9e8069fa168b6c98c0026d44434ac6e40a0b46f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11568026$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nielsen, S L</creatorcontrib><creatorcontrib>Timek, T A</creatorcontrib><creatorcontrib>Lai, D T</creatorcontrib><creatorcontrib>Daughters, G T</creatorcontrib><creatorcontrib>Liang, D</creatorcontrib><creatorcontrib>Hasenkam, J M</creatorcontrib><creatorcontrib>Ingels, N B</creatorcontrib><creatorcontrib>Miller, D C</creatorcontrib><title>Edge-to-edge mitral repair: tension on the approximating suture and leaflet deformation during acute ischemic mitral regurgitation in the ovine heart</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Edge-to-edge approximation of the mitral valve leaflets (Alfieri procedure) is a novel surgical treatment for patients with ischemic mitral regurgitation (IMR). Long-term durability may be limited if abnormal mitral leaflet stresses result from this procedure. The aim of the current study was to measure Alfieri stitch tension (F(A)) and to explore its geometric determinants in an ovine model of acute IMR as a reflection of the mitral leaflet stresses imposed by the procedure.
Eight sheep were studied immediately after surgical placement of (1) a force transducer interposed between sutures approximating the central leaflet edges and (2) radiopaque markers around the mitral annulus and leaflet edges. Computer-aided analysis of videofluorograms was used to obtained 3D marker coordinates. Simultaneous measurements of F(A), septal-lateral annular dimension (L(S-L)), leaflet edge separation (L(SEP)), anterior (L(AL)) and posterior (L(PL)) leaflet length, and hemodynamic variables were obtained at baseline (CTL) and during acute IMR (circumflex artery occlusion). F(A) was significantly elevated throughout the cardiac cycle during IMR compared with CTL, with maximum F(A) in diastole (0.26+/-0.05 versus 0.46+/-0.08 N, CTL versus IMR; P<0.05). Multivariable analysis revealed L(S-L) as the single independent predictor of maximum F(A) (P<0.001). Positive linear correlations were shown between values of F(A) and L(AL) and L(PL) (dependent variables).
These experimental data demonstrate higher F(A) during IMR and cyclic changes in F(A) closely paralleling changes in L(S-L), eg, being greatest in diastole when the annulus is largest. Increased F(A) during IMR is probably indicative of successful therapeutic intent, but higher diastolic leaflet stresses resulting from persistent or progressive mitral annular dilatation may adversely affect repair durability. This indirectly implies that concomitant mitral ring annuloplasty should be added to the Alfieri repair.</description><subject>Acute Disease</subject><subject>Animals</subject><subject>Cardiac Surgical Procedures</subject><subject>Diastole</subject><subject>Disease Models, Animal</subject><subject>Echocardiography, Doppler</subject><subject>Echocardiography, Doppler, Color</subject><subject>Fluoroscopy - methods</subject><subject>Hemodynamics</subject><subject>Mitral Valve - diagnostic imaging</subject><subject>Mitral Valve - physiopathology</subject><subject>Mitral Valve - surgery</subject><subject>Mitral Valve Insufficiency - complications</subject><subject>Mitral Valve Insufficiency - diagnosis</subject><subject>Mitral Valve Insufficiency - physiopathology</subject><subject>Mitral Valve Insufficiency - surgery</subject><subject>Multivariate Analysis</subject><subject>Myocardial Ischemia - complications</subject><subject>Sheep</subject><subject>Stress, Mechanical</subject><subject>Suture Techniques</subject><subject>Systole</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><recordid>eNpFUdtKAzEQDaLYWv0EJU--bU2ySXbXNylVCwVf9Dmk2dk2sjdzEf0Q_9eUFgoDw8ycM7eD0C0lc0olfTDWmTklfO7jOLaKzlcZq87QlArGMy7y6hxNCSFVVuSMTdCV958plHkhLtGEUiFLwuQU_S3rLWRhyCB53NngdIsdjNq6Rxyg93bocbKwA6zH0Q0_ttPB9lvsY4guJfsat6CbFgKuoRncvpwIdXR7lDYxALbe7KCz5jRgG93WhgPUHtoP37YHvAPtwjW6aHTr4eboZ-jjefm-eM3Wby-rxdM6M0zkIdOFoFyygglR1IQ2opRsU3GmKyiJrBpNZbmRpioNScfWnPOcayOBE002XDb5DN0f-qbDviL4oLq0KrSt7mGIXhWUlgWVPAHFAWjc4L2DRo0uPcL9KkrUXg-11yMFXB31UCvFqsS7Ow6Imw7qE-soQP4PJP-M0g</recordid><startdate>20010918</startdate><enddate>20010918</enddate><creator>Nielsen, S L</creator><creator>Timek, T A</creator><creator>Lai, D T</creator><creator>Daughters, G T</creator><creator>Liang, D</creator><creator>Hasenkam, J M</creator><creator>Ingels, N B</creator><creator>Miller, D C</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20010918</creationdate><title>Edge-to-edge mitral repair: tension on the approximating suture and leaflet deformation during acute ischemic mitral regurgitation in the ovine heart</title><author>Nielsen, S L ; Timek, T A ; Lai, D T ; Daughters, G T ; Liang, D ; Hasenkam, J M ; Ingels, N B ; Miller, D C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c253t-a75146272557d01f5862b942a9e8069fa168b6c98c0026d44434ac6e40a0b46f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Acute Disease</topic><topic>Animals</topic><topic>Cardiac Surgical Procedures</topic><topic>Diastole</topic><topic>Disease Models, Animal</topic><topic>Echocardiography, Doppler</topic><topic>Echocardiography, Doppler, Color</topic><topic>Fluoroscopy - methods</topic><topic>Hemodynamics</topic><topic>Mitral Valve - diagnostic imaging</topic><topic>Mitral Valve - physiopathology</topic><topic>Mitral Valve - surgery</topic><topic>Mitral Valve Insufficiency - complications</topic><topic>Mitral Valve Insufficiency - diagnosis</topic><topic>Mitral Valve Insufficiency - physiopathology</topic><topic>Mitral Valve Insufficiency - surgery</topic><topic>Multivariate Analysis</topic><topic>Myocardial Ischemia - complications</topic><topic>Sheep</topic><topic>Stress, Mechanical</topic><topic>Suture Techniques</topic><topic>Systole</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nielsen, S L</creatorcontrib><creatorcontrib>Timek, T A</creatorcontrib><creatorcontrib>Lai, D T</creatorcontrib><creatorcontrib>Daughters, G T</creatorcontrib><creatorcontrib>Liang, D</creatorcontrib><creatorcontrib>Hasenkam, J M</creatorcontrib><creatorcontrib>Ingels, N B</creatorcontrib><creatorcontrib>Miller, D C</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nielsen, S L</au><au>Timek, T A</au><au>Lai, D T</au><au>Daughters, G T</au><au>Liang, D</au><au>Hasenkam, J M</au><au>Ingels, N B</au><au>Miller, D C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Edge-to-edge mitral repair: tension on the approximating suture and leaflet deformation during acute ischemic mitral regurgitation in the ovine heart</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2001-09-18</date><risdate>2001</risdate><volume>104</volume><issue>12 Suppl 1</issue><spage>I29</spage><epage>I35</epage><pages>I29-I35</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>Edge-to-edge approximation of the mitral valve leaflets (Alfieri procedure) is a novel surgical treatment for patients with ischemic mitral regurgitation (IMR). Long-term durability may be limited if abnormal mitral leaflet stresses result from this procedure. The aim of the current study was to measure Alfieri stitch tension (F(A)) and to explore its geometric determinants in an ovine model of acute IMR as a reflection of the mitral leaflet stresses imposed by the procedure.
Eight sheep were studied immediately after surgical placement of (1) a force transducer interposed between sutures approximating the central leaflet edges and (2) radiopaque markers around the mitral annulus and leaflet edges. Computer-aided analysis of videofluorograms was used to obtained 3D marker coordinates. Simultaneous measurements of F(A), septal-lateral annular dimension (L(S-L)), leaflet edge separation (L(SEP)), anterior (L(AL)) and posterior (L(PL)) leaflet length, and hemodynamic variables were obtained at baseline (CTL) and during acute IMR (circumflex artery occlusion). F(A) was significantly elevated throughout the cardiac cycle during IMR compared with CTL, with maximum F(A) in diastole (0.26+/-0.05 versus 0.46+/-0.08 N, CTL versus IMR; P<0.05). Multivariable analysis revealed L(S-L) as the single independent predictor of maximum F(A) (P<0.001). Positive linear correlations were shown between values of F(A) and L(AL) and L(PL) (dependent variables).
These experimental data demonstrate higher F(A) during IMR and cyclic changes in F(A) closely paralleling changes in L(S-L), eg, being greatest in diastole when the annulus is largest. Increased F(A) during IMR is probably indicative of successful therapeutic intent, but higher diastolic leaflet stresses resulting from persistent or progressive mitral annular dilatation may adversely affect repair durability. This indirectly implies that concomitant mitral ring annuloplasty should be added to the Alfieri repair.</abstract><cop>United States</cop><pmid>11568026</pmid><doi>10.1161/circ.104.suppl_1.I-29</doi></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2001-09, Vol.104 (12 Suppl 1), p.I29-I35 |
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| source | EZB Electronic Journals Library |
| subjects | Acute Disease Animals Cardiac Surgical Procedures Diastole Disease Models, Animal Echocardiography, Doppler Echocardiography, Doppler, Color Fluoroscopy - methods Hemodynamics Mitral Valve - diagnostic imaging Mitral Valve - physiopathology Mitral Valve - surgery Mitral Valve Insufficiency - complications Mitral Valve Insufficiency - diagnosis Mitral Valve Insufficiency - physiopathology Mitral Valve Insufficiency - surgery Multivariate Analysis Myocardial Ischemia - complications Sheep Stress, Mechanical Suture Techniques Systole |
| title | Edge-to-edge mitral repair: tension on the approximating suture and leaflet deformation during acute ischemic mitral regurgitation in the ovine heart |
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