Abstract 14898: Utility of Novel Automated 3D Software in Selecting Annuloplasty Band Size in Repair of Advanced Mitral Valve Prolapse
Background: Accurate annuloplasty sizing is important for successful mitral valve (MV) repair surgery. Current sizing methods are performed intra-operatively in a non-physiologic state. We hypothesized that dynamic pre-operative 3D transoesophageal echo (TEE) based MV annular and leaflet measurements using a novel semi-automated software will predict the annuloplasty band size used in degenerative MV disease.
Methods: Patients referred for MV repair underwent pre-operative 3D TEE (iE33 X-7t, Philips). Semi-automated software (Siemens Medical Solutions) measured 3D
BSA indexed MV parameters at mid systole. Linear regression identified 3D TEE predictors of annuloplasty band size. The surgeon was blinded to 3D measurements.
Results: Semi-automated analysis was feasible in 40 of 46 patients (61 ± 10 yrs; 29 male) with advanced MV prolapse (2.9 ± 1.7 segments) undergoing MV repair surgery with an annuloplasty band (SimpliciT, Medtronic, size 65 ± 8mm) by an expert surgeon. 33 patients had optimal post-operative results (≤mild regurgitation, no stenosis) and so were studied to identify 3D
TEE predictors of annuloplasty size. BSA-indexed, 3D annular circumference and intercommissural distance were the strongest predictors of implanted annuloplasty band size (Figure). Amongst the parameters the 3D annular circumference is the most directly relevant measure by the software and predicted 59% of the variability in implanted band size (Fig.). In the 3 patients with >mild post-operative mitral regurgitation, the regression would have dictated a smaller (on average by 6 mm/m2; N=2) or equal (N=1) annuloplasty than implanted.
Conclusion: This is the first study to demonstrate that physiologic measurements of pre-operative 3D
BSA-indexed mitral annular circumference and intercommissural distance can predict annuloplasty band size. MV repair planning should include assessment of these parameters.
- © 2013 by American Heart Association, Inc.