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J Thorac Cardiovasc Surg 1999;117:302-309
© 1999 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

MITRAL ANNULAR SIZE AND SHAPE IN SHEEP WITH ANNULOPLASTY RINGS

From the Department of Cardiovascular and Thoracic Surgery,^a the Division of Cardiovascular Medicine,^c and the Department of Anesthesia,^e Stanford University School of Medicine, Stanford, Calif, Cardiac Surgery^f and Cardiology Sections,^d Department of Veterans Affairs Medical Center, Palo Alto, Calif, and the Department of Cardiovascular Physiology and Biophysics,^b Research Institute of the Palo Alto Medical Foundation, Palo Alto, Calif.

Presented in part at the American Heart Association Seventieth Scientific Sessions, Orlando, Fla, Nov 9-12, 1997.Supported by grants HL-29589 and HL-48837 from the National Heart, Lung and Blood Institute and the Veterans Administration Medical Research Service. Drs Glasson, Green, Dagum, and Komeda are Carl and Leah McConnell Cardiovascular Surgical Research Fellows. Dr Glasson is also a Katharine McCormick Scholar and recipient of The Thoracic Surgery Foundation Research Fellowship Award.

Received for publication Jan 23, 1998. Revisions requested April 2, 1998.; revisions received July 27, 1998. Accepted for publication Sept 29, 1998. Address for reprints: D. Craig Miller, MD, Department of Cardiovascular and Thoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5247.

Background: Mitral annuloplasty is an important element of most mitral repairs, yet the effects of various types of annuloplasty rings on mitral annular dynamics are still debated. Recent studies suggest that flexible rings preserve physiologic mitral annular area change during the cardiac cycle, while rigid rings do not.
Methods: To clarify the effects of mitral ring annuloplasty on mitral annular dynamic geometry, we sutured 8 radiopaque markers equidistantly around the mitral anulus in 3 groups of sheep (n = 7 each: no ring, Carpentier-Edwards semi-rigid Physio-Ring [Baxter Healthcare Corp, Edwards Division, Santa Ana, Calif], and Duran flexible ring [Medtronic, Inc, Minneapolis, Minn]). Ring sizes were selected according to anterior leaflet area and inter-trigonal distance (Physio-Ring 28 mm, n = 7; Duran ring 31 mm, n = 5, and 29 mm, n = 2). After 8 ± 1 days of recovery, the sheep were sedated and studied by means of biplane videofluoroscopy. Mitral annular area was calculated from 3-dimensional marker coordinates without assuming circular or planar geometry.
Results: In the no ring group, mitral annular area varied during the cardiac cycle by 11% ± 2% (mean ± SEM; maximum = 7.6 ± 0.2, minimum = 6.8 ± 0.2 cm²; P .001). Mitral annular area was fixed in the Physio-Ring group (4.6 ± 0.1 cm²) and, surprisingly, also static in the Duran ring group (4.8 ± 0.1 cm²; P = .26 vs Physio-Ring). Furthermore, mitral annular 3-dimensional shape changed in the no-ring group during the cardiac cycle, but not in the Physio-Ring or Duran groups.
Conclusions: Mitral annular area and shape did not change during the cardiac cycle after ring annuloplasty, regardless of ring type. Thus mitral annular area reduction, independent of intrinsic ring flexibility, is the chief mechanism responsible for the salutary effects of mitral ring annuloplasty.

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