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Annular Dynamics and Leaflet Geometry in Patch Reconstruction of the Posterior Mitral Leaflet After Adding a Flexible Annuloplasty Ring

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Abstract

Purpose

Patch reconstruction of the posterior mitral leaflet using small intestinal submucosa extracellular matrix has been successfully performed in a porcine study. The patch reconstruction, however, resulted in non-physiological systolic widening of the mitral annulus, suggesting the need for an annuloplasty ring. The objective was to characterize the impact on annular dynamics and leaflet geometry of adding a flexible annuloplasty ring to the posterior mitral leaflet patch reconstruction.

Methods

Measurements were performed in an acute 80-kg porcine model, with seven pigs acting as their own controls. The posterior mitral leaflet was reconstructed with a 2-ply small intestinal submucosa extracellular matrix patch (CorMatrix®). Additionally, a Simulus® Flexible Annuloplasty Ring (Medtronic Inc., Minneapolis, MN, USA) was inserted. Mitral annular dynamics were evaluated using sonomicrometry, and leaflet geometry was described using echocardiography.

Results

The annuloplasty ring reduced mitral annular dimensions and restricted cyclic changes in mitral annular area (126 ± 19 vs. 30 ± 13 mm2, p < 0.001), septal-lateral and commisure-commisure distances. Ring annuloplasty prevented systolic widening in the mitral annulus after posterior mitral leaflet reconstruction. The annular saddle shape and leaflet coaptation length (8.7 ± 2.3 vs. 9.7 ± 1.3 mm, p = 0.221) were comparable before and after ring insertion.

Conclusions

The flexible annuloplasty ring resulted in a downsized annulus with restriction of cyclic annular changes in the reconstructed mitral valve. Ring insertion preserved the annular saddle shape and coaptation length. The ring annuloplasty counteracted the non-physiological annular dynamics, and this may improve durability of the posterior mitral leaflet patch reconstruction.

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Acknowledgments

This work was supported by the Danish Heart Foundation [Grant Numbers: 16-R107-A6593-22037, 16-R107-A6593-22038, 16-R107-A6588-22041 and 16-R107-A6588-22042], the Lundbeck Foundation [Grant Number: R184-2014-2478] and the Helga and Peter Korning Foundation. The 2-ply version of small intestinal submucosal extracellular matrix material was donated by CorMatrix®. All data and intellectual rights belong to the authors.

Author contributions

All authors comply with Springer submission guidelines and qualify for being authors. All co-authors have approved submission of the present manuscript.

Funding

This work was supported by the Danish Heart Foundation [Grant Numbers: 16-R107-A6593-22037, 16-R107-A6593-22038, 16-R107-A6588-22041 and 16-R107-A6588-22042], the Lundbeck Foundation [Grant Number: R184-2014-2478] and the Helga and Peter Korning Foundation. The 2-ply version of small intestinal submucosal extracellular matrix material was donated by CorMatrix®.

Conflict of interest

The authors declare that they have no conflict of interest. The small intestinal submucosa extracellular matrix (CorMatrix®) was provided free of charge from the manufacturer. The company did not influence study design or interpretation of data. They have not influenced or approved the content of this manuscript.

Ethics approval

The study complied with the National Guidelines for Experimental Animal Research and was approved by the Danish Inspectorate of Animal Experimentation (No. 2016-15-0201-01132).

Research involving human and animal rights

No human studies were carried out by the authors for this article. All institutional and national guidelines for the care and use of laboratory animals were followed and approved by the appropriate institutional committees.

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Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark

    Karen B. Poulsen, Marcell J. Tjørnild, Søren N. Skov, Mona Sharghbin, Lisa Carlson Hanse, Leila L. Benhassen, Diana M. Røpcke, Sten L. Nielsen & J. Michael Hasenkam

  2. Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark

    Karen B. Poulsen, Marcell J. Tjørnild, Søren N. Skov, Mona Sharghbin, Lisa Carlson Hanse, Leila L. Benhassen, Diana M. Røpcke, Sten L. Nielsen & J. Michael Hasenkam

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  1. Karen B. Poulsen
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  2. Marcell J. Tjørnild
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  3. Søren N. Skov
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  4. Mona Sharghbin
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  6. Leila L. Benhassen
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  7. Diana M. Røpcke
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  8. Sten L. Nielsen
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Correspondence to Karen B. Poulsen.

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Associate Editor Jane Grande-Allen oversaw the review of this article.

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Poulsen, K.B., Tjørnild, M.J., Skov, S.N. et al. Annular Dynamics and Leaflet Geometry in Patch Reconstruction of the Posterior Mitral Leaflet After Adding a Flexible Annuloplasty Ring. Cardiovasc Eng Tech 11, 748–759 (2020). https://doi.org/10.1007/s13239-020-00502-x

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