Mitral Annular Forces and Their Potential Impact on Annuloplasty Ring Selection

Johannes Høgfeldt Jedrzejczyk; Lisa Carlson Hanse; Seyedeh Shadi Javadian Deilami; Søren Nielsen Skov; J. Michael Hasenkam; Marcell Juan Tjørnild

doi:10.3389/fcvm.2021.799994

Mitral Annular Forces and Their Potential Impact on Annuloplasty Ring Selection

Johannes Høgfeldt Jedrzejczyk^*, Lisa Carlson Hanse, Seyedeh Shadi Javadian Deilami (Illustrator), Søren Nielsen Skov, J. Michael Hasenkam, Marcell Juan Tjørnild

^*Corresponding author for this work

Department of Clinical Medicine - Department of Cardiothoracic and Vascular Surgery

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Review › Research › peer-review

Abstract

Objectives: To provide an overview that describes the characteristics of a mitral annuloplasty device when treating patients with a specific type of mitral regurgitation according to Carpentier's classification of mitral regurgitation.Methods: Starting with the key search term "mitral valve annuloplasty, " a literature search was performed utilising PubMed, Google Scholar, and Web of Science to identify relevant studies. A systematic approach was used to assess all publications.Results: Mitral annuloplasty rings are traditionally categorised by their mechanical compliance in rigid-, semi-rigid-, and flexible rings. There is a direct correlation between remodelling capabilities and rigidity. Thus, a rigid annuloplasty ring will have the highest remodelling capability, while a flexible ring will have the lowest. Rigid- and semi-rigid rings can furthermore be divided into flat and saddled-shaped rings. Saddle-shaped rings are generally preferred over flat rings since they decrease annular and leaflet stress accumulation and provide superior leaflet coaptation. Finally, mitral annuloplasty rings can either be complete or partial.Conclusions: A downsized rigid- or semi-rigid ring is advantageous when higher remodelling capabilities are required to correct dilation of the mitral annulus, as seen in type I, type IIIa, and type IIIb mitral regurgitation. In type II mitral regurgitation, a normosized flexible ring might be sufficient and allow for a more physiological repair since there is no annular dilatation, which diminishes the need for remodelling capabilities. However, mitral annuloplasty ring selection should always be based on the specific morphology in each patient.

Original language	English
Article number	799994
Journal	Frontiers in Cardiovascular Medicine
Volume	8
Number of pages	10
ISSN	2297-055X
DOIs	https://doi.org/10.3389/fcvm.2021.799994
Publication status	Published - Jan 2022

Keywords

mitral annular forces
mitral annuloplasty device
mitral regurgitation
mitral ring annuloplasty
mitral valve repair (MV repair)

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10.3389/fcvm.2021.799994Licence: CC BY

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@article{584058d6e30247e09a2475539f1634e5,

title = "Mitral Annular Forces and Their Potential Impact on Annuloplasty Ring Selection",

abstract = "Objectives: To provide an overview that describes the characteristics of a mitral annuloplasty device when treating patients with a specific type of mitral regurgitation according to Carpentier's classification of mitral regurgitation.Methods: Starting with the key search term {"}mitral valve annuloplasty, {"} a literature search was performed utilising PubMed, Google Scholar, and Web of Science to identify relevant studies. A systematic approach was used to assess all publications.Results: Mitral annuloplasty rings are traditionally categorised by their mechanical compliance in rigid-, semi-rigid-, and flexible rings. There is a direct correlation between remodelling capabilities and rigidity. Thus, a rigid annuloplasty ring will have the highest remodelling capability, while a flexible ring will have the lowest. Rigid- and semi-rigid rings can furthermore be divided into flat and saddled-shaped rings. Saddle-shaped rings are generally preferred over flat rings since they decrease annular and leaflet stress accumulation and provide superior leaflet coaptation. Finally, mitral annuloplasty rings can either be complete or partial.Conclusions: A downsized rigid- or semi-rigid ring is advantageous when higher remodelling capabilities are required to correct dilation of the mitral annulus, as seen in type I, type IIIa, and type IIIb mitral regurgitation. In type II mitral regurgitation, a normosized flexible ring might be sufficient and allow for a more physiological repair since there is no annular dilatation, which diminishes the need for remodelling capabilities. However, mitral annuloplasty ring selection should always be based on the specific morphology in each patient.",

keywords = "mitral annular forces, mitral annuloplasty device, mitral regurgitation, mitral ring annuloplasty, mitral valve repair (MV repair)",

author = "Jedrzejczyk, {Johannes H{\o}gfeldt} and {Carlson Hanse}, Lisa and Deilami, {Seyedeh Shadi Javadian} and Skov, {S{\o}ren Nielsen} and Hasenkam, {J. Michael} and Tj{\o}rnild, {Marcell Juan}",

year = "2022",

month = jan,

doi = "10.3389/fcvm.2021.799994",

language = "English",

volume = "8",

journal = "Frontiers in Cardiovascular Medicine",

issn = "2297-055X",

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Mitral Annular Forces and Their Potential Impact on Annuloplasty Ring Selection. / Jedrzejczyk, Johannes Høgfeldt ; Carlson Hanse, Lisa; Deilami, Seyedeh Shadi Javadian (Illustrator) et al.
In: Frontiers in Cardiovascular Medicine, Vol. 8, 799994, 01.2022.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Review › Research › peer-review

TY - JOUR

T1 - Mitral Annular Forces and Their Potential Impact on Annuloplasty Ring Selection

AU - Jedrzejczyk, Johannes Høgfeldt

AU - Carlson Hanse, Lisa

AU - Skov, Søren Nielsen

AU - Hasenkam, J. Michael

AU - Tjørnild, Marcell Juan

A2 - Deilami, Seyedeh Shadi Javadian

PY - 2022/1

Y1 - 2022/1

N2 - Objectives: To provide an overview that describes the characteristics of a mitral annuloplasty device when treating patients with a specific type of mitral regurgitation according to Carpentier's classification of mitral regurgitation.Methods: Starting with the key search term "mitral valve annuloplasty, " a literature search was performed utilising PubMed, Google Scholar, and Web of Science to identify relevant studies. A systematic approach was used to assess all publications.Results: Mitral annuloplasty rings are traditionally categorised by their mechanical compliance in rigid-, semi-rigid-, and flexible rings. There is a direct correlation between remodelling capabilities and rigidity. Thus, a rigid annuloplasty ring will have the highest remodelling capability, while a flexible ring will have the lowest. Rigid- and semi-rigid rings can furthermore be divided into flat and saddled-shaped rings. Saddle-shaped rings are generally preferred over flat rings since they decrease annular and leaflet stress accumulation and provide superior leaflet coaptation. Finally, mitral annuloplasty rings can either be complete or partial.Conclusions: A downsized rigid- or semi-rigid ring is advantageous when higher remodelling capabilities are required to correct dilation of the mitral annulus, as seen in type I, type IIIa, and type IIIb mitral regurgitation. In type II mitral regurgitation, a normosized flexible ring might be sufficient and allow for a more physiological repair since there is no annular dilatation, which diminishes the need for remodelling capabilities. However, mitral annuloplasty ring selection should always be based on the specific morphology in each patient.

AB - Objectives: To provide an overview that describes the characteristics of a mitral annuloplasty device when treating patients with a specific type of mitral regurgitation according to Carpentier's classification of mitral regurgitation.Methods: Starting with the key search term "mitral valve annuloplasty, " a literature search was performed utilising PubMed, Google Scholar, and Web of Science to identify relevant studies. A systematic approach was used to assess all publications.Results: Mitral annuloplasty rings are traditionally categorised by their mechanical compliance in rigid-, semi-rigid-, and flexible rings. There is a direct correlation between remodelling capabilities and rigidity. Thus, a rigid annuloplasty ring will have the highest remodelling capability, while a flexible ring will have the lowest. Rigid- and semi-rigid rings can furthermore be divided into flat and saddled-shaped rings. Saddle-shaped rings are generally preferred over flat rings since they decrease annular and leaflet stress accumulation and provide superior leaflet coaptation. Finally, mitral annuloplasty rings can either be complete or partial.Conclusions: A downsized rigid- or semi-rigid ring is advantageous when higher remodelling capabilities are required to correct dilation of the mitral annulus, as seen in type I, type IIIa, and type IIIb mitral regurgitation. In type II mitral regurgitation, a normosized flexible ring might be sufficient and allow for a more physiological repair since there is no annular dilatation, which diminishes the need for remodelling capabilities. However, mitral annuloplasty ring selection should always be based on the specific morphology in each patient.

KW - mitral annular forces

KW - mitral annuloplasty device

KW - mitral regurgitation

KW - mitral ring annuloplasty

KW - mitral valve repair (MV repair)

UR - http://www.scopus.com/inward/record.url?scp=85127379885&partnerID=8YFLogxK

U2 - 10.3389/fcvm.2021.799994

DO - 10.3389/fcvm.2021.799994

M3 - Review

C2 - 35059450

SN - 2297-055X

VL - 8

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

M1 - 799994

ER -

Mitral Annular Forces and Their Potential Impact on Annuloplasty Ring Selection

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