Abstract 3241: Quantitation of Mitral Annular Structure and Function in Organic Mitral Regurgitation: Effect of Valve Repair and Comparison of the Modified Carpentier Method With a New “American Correction”
Objective: Mitral repair is the preferred operation for patients with significant organic mitral regurgitation (MR). A new surgical technique “the American Correction” (AC) involves a complete full flexible ring, artificial chordal insertion but without annular and leaflet resection, with the intention of preserving annular function. The aim of the study was to compare changes in mitral annular (MA) structure and function after the AC technique with that of a Modified Carpentier method (MC) (involves leaflet reduction and annuloplasty with partial ring).
Methods: Patients with organic severe MR undergoing mitral valve repair with either techniques underwent a 3D Transesophageal Echocardiography prior to and after surgery. The AC and MC operations were performed in two different Institutions. The MA was tracked off-line and measured throughout the cardiac cycle (MVQ, Philips). The annular parameters measured were: MA area, diameters, height and circumference. Changes in these parameters during the cardiac cycle, and before and after repair, were compared between the two surgical techniques.
Results: There were 15 patients who underwent repair with AC and 15 with MC (age 56 vs.60 years, 10 males in each respectively). Surgical repair was successful in all patients. A flexible partial ring (Simplisit-y/SJ Tailor) was placed in all MC patients. A significant reduction in MA area occurred after repair with either method (MA 3D area: from 19.2±4 cm2 to 7.7±1.8 cm2 with AC, from 19.9±5 cm2 to 6.2±1.6 cm2 with MC; p<0.001 for both). Reduction in the other parameters of MA height and diameters were also seen by both methods (p<0.001). However, percent reduction in MA 3D area after surgery was less with AC compared to MC (60% vs. 68%; p <0.001). Furthermore mitral annular dynamic function measured as percent change during the cardiac cycle was more preserved with AC compared to MC (MA area change during the cardiac cycle after repair: 11% vs. 7%; p<0.001).
Conclusion: Mitral annular size is reduced with surgical repair, irrespective of the approach. However, the MA area is larger and has more preserved function with the “American Correction”, which does not involve surgical leaflet resection. This may have clinical implications on mitral valve structure and function.