Undersizing mitral annuloplasty alters left ventricular mechanics in a swine model of ischemic mitral regurgitation

被引:3
作者
Xu, Dongyang [1 ]
McBride, Erin [1 ]
Kalra, Kanika [1 ]
Wong, Keawepono [1 ]
Guyton, Robert A. [1 ,2 ]
Sarin, Eric L. [1 ,3 ]
Padala, Muralidhar [1 ,2 ]
机构
[1] Emory Univ Hosp Midtown, Carlyle Fraser Heart Ctr, Struct Heart Res & Innovat Lab, Atlanta, GA USA
[2] Emory Univ, Div Cardiothorac Surg, Dept Surg, 380B Northyards Blvd, Atlanta, GA 30322 USA
[3] Inova Heart & Vasc Inst, Dept Cardiothorac Surg, Fairfax, VA USA
基金
美国国家卫生研究院;
关键词
ischemic mitral regurgitation; secondary mitral regurgitation; functional mitral regurgitation; heart failure; annuloplasty; mitral valve repair; mitral valve replacement; MYOCARDIAL-INFARCTION; EJECTION FRACTION; SYSTOLIC FUNCTION; MORTALITY; REPAIR;
D O I
10.1016/j.jtcvs.2020.09.141
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Undersizing mitral annuloplasty (UMA) is a frequently used surgical repair technique to correct ischemic mitral regurgitation in patients with heart failure. In this study, we sought to test the hypothesis that downsizing the mitral annulus can adversely affect the shape and mechanics of the left ventricle inhibiting its functional recovery. Methods: Eighteen farm swine that underwent an inferolateral myocardial infarction and developed ischemic mitral regurgitation of >2+ severity after 2 months were assigned as follows: 9 swine received an undersized mitral annuloplasty, 6 received papillary muscle approximation (PMA), and 3 animals did not receive any other intervention. Animals lived another 3 months and cardiac magnetic resonance imaging was performed before termination to assess ventricle mechanics and function. Results: Ejection fraction was comparable between the 2 repair groups before surgery, but was significantly lower in UMA at 38.89% +/- 7.91% versus 50.83% +/- 9.04% in the PMA group (P = .0397). Animals receiving UMA had lower regional peak fractional shortening and reduced systolic and diastolic radial velocities compared with PMA and in some regions were lower than sham. Animals that underwent UMA had higher circumferential strain than sham, but lower than PMA. UMA animals have lower longitudinal strain compared to sham group and lower LV torsion than PMA. Conclusions: Undersizing the mitral annulus with an annuloplasty ring can restore valvular competence, but unphysiologically impair ventricle mechanics. Mitral valve repair strategies should focus not only on restoring valve competence, but preserving ventricle mechanics.
引用
收藏
页码:850 / +
页数:20
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