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Jeroen J Bax - One of the best experts on this subject based on the ideXlab platform.

  • cardiac support device restrictive Mitral valve Annuloplasty and optimized medical treatment a multimodality approach to nonischemic cardiomyopathy
    The Journal of Thoracic and Cardiovascular Surgery, 2011
    Co-Authors: Jerry Braun, Victoria Delgado, Jeroen J Bax, Martin J Schalij, Michel I M Versteegh, Eric Boersma, R Dion, Agnieszka Ciarka, Harriette F Verwey, Nico R Van De Veire
    Abstract:

    Objective Nonischemic dilated cardiomyopathy with functional Mitral regurgitation carries a poor prognosis. Mitral valve surgery with implantation of a cardiac support device can treat Mitral regurgitation and promote left ventricular reverse remodeling. This observational study evaluates clinical and echocardiographic outcomes of an individualized medico–surgical approach, focusing on Mitral regurgitation recurrence and left ventricular reverse remodeling. Methods Sixty-nine consecutive patients with heart failure (New York Heart Association class III/IV) with functional Mitral regurgitation (grade 3+/4+) and left ventricular remodeling (end-diastolic volume 227 ± 73 mL, ejection fraction 26% ± 8%) underwent restrictive Mitral Annuloplasty (median ring size 26), with (n = 41) or without (n = 28) a cardiac support device and optimal postoperative medical treatment. Patients were clinically and echocardiographically evaluated at up to 3.1 years’ median follow-up. Results Early mortality was 5.8%. Actuarial survival at 1, 2, and 5 years was 86% ± 4%, 79% ± 5%, and 63% ± 7%. New York Heart Association class improved from 3.1 ± 0.4 to 2.0 ± 0.5 ( P P  = .007), and in a trend toward less recurrent Mitral regurgitation of grade 2+ or more (actuarial freedom at 3 years 89% ± 8% vs 63% ± 11%; P  = .067). Conclusions An individualized medico–surgical approach to nonischemic cardiomyopathy combining restrictive Mitral Annuloplasty, cardiac support device implantation, and optimal medical management leads to favorable survival and improved functional status, low incidence of significant recurrent Mitral regurgitation, and sustained left ventricular reverse remodeling.

  • first in man implantation of a trans catheter aortic valve in a Mitral Annuloplasty ring novel treatment modality for failed Mitral valve repair
    European Journal of Cardio-Thoracic Surgery, 2011
    Co-Authors: Arend De Weger, See Hooi Ewe, Victoria Delgado, Jeroen J Bax
    Abstract:

    The trans-catheter valve-in-valve concept has become a feasible therapeutic option for patients with failing degenerated bioprosthesis, who are deemed inoperable. However, little is known about the feasibility of this technique in failed valve Annuloplasty. We report the first-in-man implantation of a trans-catheter aortic valve within a Mitral Annuloplasty ring. Through a trans-apical trans-catheter approach, a 26-mm Sapien-Edwards valve was successfully implanted in a 72-year-old man with ischemic heart failure and failed Mitral-valve Annuloplasty. The present case report provides a critical appraisal of the procedural technique.

  • long term effects of surgical ventricular restoration with additional restrictive Mitral Annuloplasty and or coronary artery bypass grafting on left ventricular function six month follow up by pressure volume loops
    The Journal of Thoracic and Cardiovascular Surgery, 2010
    Co-Authors: Ellen Ten A Brinke, Jeroen J Bax, Martin J Schalij, Robert J M Klautz, Sven A F Tulner, Ernst E Van Der Wall, Robert A E Dion, Michel I M Versteegh, Harriette F Verwey, Paul Steendijk
    Abstract:

    Objectives Previous studies demonstrated beneficial short-term effects of surgical ventricular restoration on mechanical dyssynchrony and left ventricular function and improved midterm and long-term clinical parameters. However, long-term effects on systolic and diastolic left ventricular function are still largely unknown. Methods We studied 9 patients with ischemic dilated cardiomyopathy who underwent surgical ventricular restoration with additional restrictive Mitral Annuloplasty and/or coronary artery bypass grafting. Invasive hemodynamic measurements by conductance catheter (pressure–volume loops) were obtained before and 6 months after surgery. In addition, New York Heart Association classification, quality-of-life score, and 6-minute hall-walk test were assessed. Results At 6 months' follow-up, all patients were alive and clinically in improved condition: New York Heart Association class from 3.3 ± 0.5 to 1.4 ± 0.7, quality-of-life score from 46 ± 22 to 15 ± 15, and 6-minute hall-walk test from 302 ± 123 to 444 ± 78 m (all P P  = .05), and left ventricular ejection fraction (36% ± 10% to 46% ± 10%; P P P P −1 ( P Conclusions Surgical ventricular restoration with additional restrictive Mitral Annuloplasty and/or coronary artery bypass grafting leads to sustained left ventricular volume reduction at 6 months' follow-up. We observed improved systolic function and unchanged early diastolic function but impaired passive diastolic properties. Clinical improvement, supported by decreased New York Heart Association class, improved quality-of-life score, and improved 6-minute hall-walk test may be related to improved systolic function, reduced mechanical dyssynchrony, and reduced wall stress.

  • predictors of Mitral regurgitation recurrence in patients with heart failure undergoing Mitral valve Annuloplasty
    American Journal of Cardiology, 2010
    Co-Authors: Agnieszka Ciarka, Victoria Delgado, Jeroen J Bax, Robert J M Klautz, Robert A E Dion, Jerry Braun, Michel I M Versteegh, Eric Boersma, Nico R Van De Veire
    Abstract:

    Restrictive Mitral Annuloplasty is a surgical treatment option for patients with heart failure (HF) and functional Mitral regurgitation (MR). However, recurrent MR has been reported at mid-term follow-up. The aim of the present study was to identify the echocardiographic predictors of recurrent MR in patients with HF undergoing Mitral Annuloplasty. During a mean follow-up of 2.6 ± 1.6 years, 109 patients with HF (49% ischemic and 51% idiopathic dilated cardiomyopathy) who had undergone Mitral valve repair were followed up (of 122 total patients). The severity of MR was quantified, and the following parameters were measured before intervention and at the mid-term follow-up examination: left ventricular (LV) and left atrial volumes and dimensions, LV sphericity index, Mitral annular area, and Mitral valve geometry parameters. At mid-term follow-up, 21 patients presented with significant MR (grade 2 to 4), and 88 patients had only MR grade 0 to 1. Both groups of patients had had a similar preoperative MR grade, Mitral annular area, and LV volume and dimension. In contrast, patients with recurrent MR had had increased preoperative posterior and anterior leaflet angles, tenting height, tenting area, and LV sphericity index compared to the patients without recurrent MR. Of the different parameters of Mitral and LV geometry, the distal Mitral anterior leaflet angle (hazard ratio 1.48, 95% confidence interval 1.32 to 1.66, p <0.001) and posterior leaflet angle (hazard ratio 1.13, 95% confidence interval 1.07 to 1.19, p <0.001) were independent determinants of MR at mid-term follow-up. In conclusion, in patients with HF of ischemic or idiopathic etiology and functional MR, distal Mitral leaflet tethering and posterior Mitral leaflet tethering were associated with recurrent MR after restrictive Mitral Annuloplasty.

  • restrictive Mitral Annuloplasty cures ischemic Mitral regurgitation and heart failure
    The Annals of Thoracic Surgery, 2008
    Co-Authors: Jerry Braun, Jeroen J Bax, Robert J M Klautz, Ernst E Van Der Wall, Eduard R Holman, Michel I M Versteegh, Eric Boersma, Nico R Van De Veire, Jos J M Westenberg, R Dion
    Abstract:

    Background Restrictive Mitral Annuloplasty with revascularization is considered the best approach to ischemic Mitral regurgitation with heart failure, but late results are controversial. We report late outcome in relation to preoperative left ventricular end-diastolic diameter (LVEDD) cutoff values, previously identified to predict intermediate-term left ventricular reverse remodeling. Methods One hundred consecutive ischemic Mitral regurgitation patients underwent restrictive Mitral Annuloplasty (stringent downsizing by two ring sizes; median size, 26) and coronary revascularization. Survivors were clinically and echocardiographically assessed at intermediate (18 months) and late (mean, 46 months) follow-up. Results Early mortality was 8%, and late mortality was 18%. Actuarial 1-, 3-, and 5-year survival rates were 87% ± 3.4%, 80% ± 4.1%, and 71% ± 5.1%. Mortality predictors (Cox regression) were preoperative inotropic support (hazard ratio, 6.2; 95% confidence interval, 2.3 to 16.9) and preoperative LVEDD greater than 65 mm (hazard ratio, 4.5; 95% confidence interval, 1.9 to 10.9). Five-year survival rate for patients with LVEDD of 65 mm or less was 80% ± 5.2%, versus 49% ± 11% for LVEDD greater than 65 mm ( p = 0.002). At 4.3 years' follow-up, New York Heart Association functional class had improved from 2.9 ± 0.8 to 1.6 ± 0.6 ( p Conclusions At 4.3 years' follow-up, intermediate-term cutoff values for left ventricular reverse remodeling proved to be predictors for late mortality. For patients with preoperative LVEDD of 65 mm or less, restrictive Mitral Annuloplasty with revascularization provides a cure for ischemic Mitral regurgitation and heart failure; however, when LVEDD exceeds 65 mm, outcome is poor and a ventricular approach should be considered.

Victoria Delgado - One of the best experts on this subject based on the ideXlab platform.

  • cardiac support device restrictive Mitral valve Annuloplasty and optimized medical treatment a multimodality approach to nonischemic cardiomyopathy
    The Journal of Thoracic and Cardiovascular Surgery, 2011
    Co-Authors: Jerry Braun, Victoria Delgado, Jeroen J Bax, Martin J Schalij, Michel I M Versteegh, Eric Boersma, R Dion, Agnieszka Ciarka, Harriette F Verwey, Nico R Van De Veire
    Abstract:

    Objective Nonischemic dilated cardiomyopathy with functional Mitral regurgitation carries a poor prognosis. Mitral valve surgery with implantation of a cardiac support device can treat Mitral regurgitation and promote left ventricular reverse remodeling. This observational study evaluates clinical and echocardiographic outcomes of an individualized medico–surgical approach, focusing on Mitral regurgitation recurrence and left ventricular reverse remodeling. Methods Sixty-nine consecutive patients with heart failure (New York Heart Association class III/IV) with functional Mitral regurgitation (grade 3+/4+) and left ventricular remodeling (end-diastolic volume 227 ± 73 mL, ejection fraction 26% ± 8%) underwent restrictive Mitral Annuloplasty (median ring size 26), with (n = 41) or without (n = 28) a cardiac support device and optimal postoperative medical treatment. Patients were clinically and echocardiographically evaluated at up to 3.1 years’ median follow-up. Results Early mortality was 5.8%. Actuarial survival at 1, 2, and 5 years was 86% ± 4%, 79% ± 5%, and 63% ± 7%. New York Heart Association class improved from 3.1 ± 0.4 to 2.0 ± 0.5 ( P P  = .007), and in a trend toward less recurrent Mitral regurgitation of grade 2+ or more (actuarial freedom at 3 years 89% ± 8% vs 63% ± 11%; P  = .067). Conclusions An individualized medico–surgical approach to nonischemic cardiomyopathy combining restrictive Mitral Annuloplasty, cardiac support device implantation, and optimal medical management leads to favorable survival and improved functional status, low incidence of significant recurrent Mitral regurgitation, and sustained left ventricular reverse remodeling.

  • first in man implantation of a trans catheter aortic valve in a Mitral Annuloplasty ring novel treatment modality for failed Mitral valve repair
    European Journal of Cardio-Thoracic Surgery, 2011
    Co-Authors: Arend De Weger, See Hooi Ewe, Victoria Delgado, Jeroen J Bax
    Abstract:

    The trans-catheter valve-in-valve concept has become a feasible therapeutic option for patients with failing degenerated bioprosthesis, who are deemed inoperable. However, little is known about the feasibility of this technique in failed valve Annuloplasty. We report the first-in-man implantation of a trans-catheter aortic valve within a Mitral Annuloplasty ring. Through a trans-apical trans-catheter approach, a 26-mm Sapien-Edwards valve was successfully implanted in a 72-year-old man with ischemic heart failure and failed Mitral-valve Annuloplasty. The present case report provides a critical appraisal of the procedural technique.

  • first in man implantation of a trans catheter aortic valve in a Mitral Annuloplasty ring novel treatment modality for failed Mitral valve repair
    European Journal of Cardio-Thoracic Surgery, 2011
    Co-Authors: Arend De Weger, Victoria Delgado
    Abstract:

    The trans-catheter valve-in-valve concept has become a feasible therapeutic option for patients with failing degenerated bioprosthesis, who are deemed inoperable. However, little is known about the feasibility of this technique in failed valve Annuloplasty. We report the first-in-man implantation of a trans-catheter aortic valve within a Mitral Annuloplasty ring. Through a trans-apical trans-catheter approach, a 26-mm SapienEdwards valve was successfully implanted in a 72-year-old man with ischemic heart failure and failed Mitral-valve Annuloplasty. The present case report provides a critical appraisal of the procedural technique. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  • predictors of Mitral regurgitation recurrence in patients with heart failure undergoing Mitral valve Annuloplasty
    American Journal of Cardiology, 2010
    Co-Authors: Agnieszka Ciarka, Victoria Delgado, Jeroen J Bax, Robert J M Klautz, Robert A E Dion, Jerry Braun, Michel I M Versteegh, Eric Boersma, Nico R Van De Veire
    Abstract:

    Restrictive Mitral Annuloplasty is a surgical treatment option for patients with heart failure (HF) and functional Mitral regurgitation (MR). However, recurrent MR has been reported at mid-term follow-up. The aim of the present study was to identify the echocardiographic predictors of recurrent MR in patients with HF undergoing Mitral Annuloplasty. During a mean follow-up of 2.6 ± 1.6 years, 109 patients with HF (49% ischemic and 51% idiopathic dilated cardiomyopathy) who had undergone Mitral valve repair were followed up (of 122 total patients). The severity of MR was quantified, and the following parameters were measured before intervention and at the mid-term follow-up examination: left ventricular (LV) and left atrial volumes and dimensions, LV sphericity index, Mitral annular area, and Mitral valve geometry parameters. At mid-term follow-up, 21 patients presented with significant MR (grade 2 to 4), and 88 patients had only MR grade 0 to 1. Both groups of patients had had a similar preoperative MR grade, Mitral annular area, and LV volume and dimension. In contrast, patients with recurrent MR had had increased preoperative posterior and anterior leaflet angles, tenting height, tenting area, and LV sphericity index compared to the patients without recurrent MR. Of the different parameters of Mitral and LV geometry, the distal Mitral anterior leaflet angle (hazard ratio 1.48, 95% confidence interval 1.32 to 1.66, p <0.001) and posterior leaflet angle (hazard ratio 1.13, 95% confidence interval 1.07 to 1.19, p <0.001) were independent determinants of MR at mid-term follow-up. In conclusion, in patients with HF of ischemic or idiopathic etiology and functional MR, distal Mitral leaflet tethering and posterior Mitral leaflet tethering were associated with recurrent MR after restrictive Mitral Annuloplasty.

Robert A E Dion - One of the best experts on this subject based on the ideXlab platform.

  • long term effects of surgical ventricular restoration with additional restrictive Mitral Annuloplasty and or coronary artery bypass grafting on left ventricular function six month follow up by pressure volume loops
    The Journal of Thoracic and Cardiovascular Surgery, 2010
    Co-Authors: Ellen Ten A Brinke, Jeroen J Bax, Martin J Schalij, Robert J M Klautz, Sven A F Tulner, Ernst E Van Der Wall, Robert A E Dion, Michel I M Versteegh, Harriette F Verwey, Paul Steendijk
    Abstract:

    Objectives Previous studies demonstrated beneficial short-term effects of surgical ventricular restoration on mechanical dyssynchrony and left ventricular function and improved midterm and long-term clinical parameters. However, long-term effects on systolic and diastolic left ventricular function are still largely unknown. Methods We studied 9 patients with ischemic dilated cardiomyopathy who underwent surgical ventricular restoration with additional restrictive Mitral Annuloplasty and/or coronary artery bypass grafting. Invasive hemodynamic measurements by conductance catheter (pressure–volume loops) were obtained before and 6 months after surgery. In addition, New York Heart Association classification, quality-of-life score, and 6-minute hall-walk test were assessed. Results At 6 months' follow-up, all patients were alive and clinically in improved condition: New York Heart Association class from 3.3 ± 0.5 to 1.4 ± 0.7, quality-of-life score from 46 ± 22 to 15 ± 15, and 6-minute hall-walk test from 302 ± 123 to 444 ± 78 m (all P P  = .05), and left ventricular ejection fraction (36% ± 10% to 46% ± 10%; P P P P −1 ( P Conclusions Surgical ventricular restoration with additional restrictive Mitral Annuloplasty and/or coronary artery bypass grafting leads to sustained left ventricular volume reduction at 6 months' follow-up. We observed improved systolic function and unchanged early diastolic function but impaired passive diastolic properties. Clinical improvement, supported by decreased New York Heart Association class, improved quality-of-life score, and improved 6-minute hall-walk test may be related to improved systolic function, reduced mechanical dyssynchrony, and reduced wall stress.

  • predictors of Mitral regurgitation recurrence in patients with heart failure undergoing Mitral valve Annuloplasty
    American Journal of Cardiology, 2010
    Co-Authors: Agnieszka Ciarka, Victoria Delgado, Jeroen J Bax, Robert J M Klautz, Robert A E Dion, Jerry Braun, Michel I M Versteegh, Eric Boersma, Nico R Van De Veire
    Abstract:

    Restrictive Mitral Annuloplasty is a surgical treatment option for patients with heart failure (HF) and functional Mitral regurgitation (MR). However, recurrent MR has been reported at mid-term follow-up. The aim of the present study was to identify the echocardiographic predictors of recurrent MR in patients with HF undergoing Mitral Annuloplasty. During a mean follow-up of 2.6 ± 1.6 years, 109 patients with HF (49% ischemic and 51% idiopathic dilated cardiomyopathy) who had undergone Mitral valve repair were followed up (of 122 total patients). The severity of MR was quantified, and the following parameters were measured before intervention and at the mid-term follow-up examination: left ventricular (LV) and left atrial volumes and dimensions, LV sphericity index, Mitral annular area, and Mitral valve geometry parameters. At mid-term follow-up, 21 patients presented with significant MR (grade 2 to 4), and 88 patients had only MR grade 0 to 1. Both groups of patients had had a similar preoperative MR grade, Mitral annular area, and LV volume and dimension. In contrast, patients with recurrent MR had had increased preoperative posterior and anterior leaflet angles, tenting height, tenting area, and LV sphericity index compared to the patients without recurrent MR. Of the different parameters of Mitral and LV geometry, the distal Mitral anterior leaflet angle (hazard ratio 1.48, 95% confidence interval 1.32 to 1.66, p <0.001) and posterior leaflet angle (hazard ratio 1.13, 95% confidence interval 1.07 to 1.19, p <0.001) were independent determinants of MR at mid-term follow-up. In conclusion, in patients with HF of ischemic or idiopathic etiology and functional MR, distal Mitral leaflet tethering and posterior Mitral leaflet tethering were associated with recurrent MR after restrictive Mitral Annuloplasty.

  • surgical ventricular restoration in patients with ischemic dilated cardiomyopathy evaluation of systolic and diastolic ventricular function wall stress dyssynchrony and mechanical efficiency by pressure volume loops
    The Journal of Thoracic and Cardiovascular Surgery, 2006
    Co-Authors: Sven A F Tulner, Jeroen J Bax, Martin J Schalij, Robert J M Klautz, Paul Steendijk, Ernst E Van Der Wall, Robert A E Dion
    Abstract:

    Objectives: Surgical ventricular restoration aims at improving cardiac function by normalization of left ventricular shape and size. Recent studies indicate that surgical ventricular restoration is highly effective with an excellent 5-year outcome in patients with ischemic dilated cardiomyopathy. We used pressure-volume analysis to investigate acute changes in systolic and diastolic left ventricular function, mechanical dyssynchrony and efficiency, and wall stress. Methods: In 3 patient groups (total, n 33), pressure-volume loops were measured by conductance catheter before and after surgery. The main study group consisted of 10 patients with ischemic dilated cardiomyopathy (New York Heart Association class III/IV, left ventricular ejection fraction 30%) who had surgical ventricular restoration and coronary artery bypass grafting. In this group, 7 patients had additional restrictive Mitral Annuloplasty. To assess potential confounding effects of restrictive Mitral Annuloplasty and cardiopulmonary bypass, we included a group of 10 patients (New York Heart Association class III/IV, left ventricular ejection fraction 30%) who had isolated restrictive Mitral Annuloplasty and a group of 13 patients with preserved left ventricular function who had isolated coronary artery bypass grafting. Results: After surgical ventricular restoration, end-diastolic and end-systolic volumes were reduced from 211 54 to 169 34 mL (P .03) and from 147 41 to 110 59 mL (P .04), respectively. Left ventricular ejection fraction (from 27% 7% to 37% 13%, P .04) and end-systolic elastance (from 1.12 0.71 to 1.57 0.63 mm Hg/mL, P .03) improved. Peak wall stress (from 358 108 to 244 79 mm Hg, P .01) and mechanical dyssynchrony (from 26% 4% to 19% 6%, P .01) were reduced, whereas mechanical efficiency improved (from 0.34 13 to 0.49 0.14, P .03). End-diastolic pressure increased (from 13 6t o 20 5m m Hg,P .01), whereas the diastolic chamber stiffness constant tended to be increased (from 0.021 0.009 to 0.037 0.021 mL 1 , NS).

  • preoperative left ventricular dimensions predict reverse remodeling following restrictive Mitral Annuloplasty in ischemic Mitral regurgitation
    European Journal of Cardio-Thoracic Surgery, 2005
    Co-Authors: Jerry Braun, Jeroen J Bax, Robert J M Klautz, Eduard R Holman, Michel I M Versteegh, Eric Boersma, Pieter Voigt, Robert A E Dion
    Abstract:

    Objective: Ischemic Mitral regurgitation can be treated with a restrictive Mitral Annuloplasty, with or without coronary revascularization. In this study, the extent of reverse remodeling of the left ventricle following this strategy is assessed, as well as the factors that influence it. Methods: Eighty-seven consecutive patients with ischemic Mitral regurgitation and a mean ejection fraction of 32G10% underwent restrictive Mitral Annuloplasty (downsizing by two ring sizes, median ring size 26), with additional coronary revascularization in 75 patients. All underwent transthoracic echocardiography 18 months after surgery to assess residual Mitral regurgitation, Mitral valve gradient and left ventricular endsystolic and end-diastolic dimensions. Univariate and multivariate analysis was performed to identify predictors for reverse remodeling, defined as a 10% reduction in left ventricular dimension. Receiver-operating characteristic analysis was used to identify cut-off values for preoperative left ventricular dimensions in predicting reverse remodeling. Results: Early mortality was 8.0% (seven patients, three non-cardiac), late mortality was 7.5% (six patients, four non-cardiac). There were two reoperations (redo Annuloplasty), and four readmissions for heart failure. At 29 months follow-up, NYHA class improved from 3.0G0.9 to 1.3G0.5 (P!0.01). Mitral regurgitation grade decreased from 3.1G0.5 to 0.6G0.6 at 18 months, left ventricular end-systolic dimension decreased from 52G 8t o 44G11 mm (P!0.01), and end-diastolic dimension from 64G 8t o 58G10 mm (P!0.01). Multivariate analysis identified preoperative left ventricular end-diastolic dimension as the single best factor in predicting occurrence of reverse remodeling. For end-systolic dimension, 51 mm was the optimal cut-off value to predict reverse remodeling (specificity and sensitivity 81%, area under curve 0.85); for end-diastolic dimension, the cut-off value was 65 mm (specificity and sensitivity 89%, area under curve 0.92). Conclusions: Stringent restrictive Mitral Annuloplasty with or without revascularization provides excellent clinical results with acceptable mortality. At 18 months follow-up, there is no significant residual Mitral regurgitation. Reverse remodeling occurs in the majority of patients, but is limited by preoperative left ventricular dimensions. In patients with a left ventricular end-diastolic dimension exceeding 65 mm, additional surgical procedures are necessary to try and obtain reverse remodeling in this subgroup. q 2005 Elsevier B.V. All rights reserved.

Ajit P Yoganathan - One of the best experts on this subject based on the ideXlab platform.

  • optimized Mitral Annuloplasty ring design reduces loading in the posterior annulus
    The Journal of Thoracic and Cardiovascular Surgery, 2020
    Co-Authors: Beatrice Ncho, Joseph H Gorman, Robert C Gorman, Eric L Pierce, Charles H Bloodworth, Akito Imai, Keitaro Okamoto, Yoshiaki Saito, Ajit P Yoganathan
    Abstract:

    Abstract Objective The study objective was to develop a novel Annuloplasty ring with regional flexibility and assess its suture force dynamics in healthy ovine subjects compared with fully rigid or fully flexible rings. Methods Materially heterogeneous rings were created with rigid anterior and posterior, and flexible commissural segments. These rings were created to match the geometry of the Profile 3D ring (Medtronic, Minneapolis, Minn). Each ring was instrumented with 10 force transducers to measure cyclic suture forces (FC) and undersized Annuloplasty was performed in 6 healthy ovine subjects. Each FC was recorded and examined for cardiac cycles reaching a maximum left ventricular pressure of 100, 125, and 150 mm Hg. FC was compared with previously reported values from fully rigid Profile 3D and fully flexible prototype rings. Results Relative to the fully rigid ring, the heterogeneous ring exhibited 48% reduction in FC at its commissural (rigid vs heterogeneous: 1.80 ± 0.94 N vs 0.95 ± 0.52 N; P  Conclusions The reduced FC of the heterogeneous ring relative to the fully rigid ring suggests a promising approach to reduce suture loading while preserving the annular remodeling capability of fully rigid rings. Future studies in diseased subjects are necessary to explore repair effectiveness of this ring.

  • Mitral Annuloplasty ring flexibility preferentially reduces posterior suture forces
    Journal of Biomechanics, 2018
    Co-Authors: Eric L Pierce, Joseph H Gorman, Robert C Gorman, Charles H Bloodworth, Akito Imai, Keitaro Okamoto, Yoshiaki Saito, Ajit P Yoganathan
    Abstract:

    Abstract Annuloplasty ring repair is a common procedure for the correction of Mitral valve regurgitation. Commercially available rings vary in dimensions and material properties. Annuloplasty ring suture dehiscence from the native annulus is a catastrophic yet poorly understood phenomenon that has been reported across ring types. Recognizing that sutures typically dehisce from the structurally weaker posterior annulus, our group is conducting a multi-part study in search of ring design parameters that influence forces acting on posterior annular sutures in the beating heart. Herein, we report the effect of ring rigidity on suture forces. Measurements utilized custom force sensors, attached to Annuloplasty rings and implanted in normal ovine subjects via standard surgical procedure. Tested rings included the semi-rigid Physio (Edwards Lifesciences) and rigid and flexible prototypes of matching geometry. While no significant differences due to ring stiffness existed for sutures in the anterior region, posterior forces were significantly reduced with use of the flexible ring (rigid: 1.95 ± 0.96 N, semi-rigid: 1.76 ± 1.19 N, flexible: 1.04 ± 0.63 N; p

  • Mitral Annuloplasty ring suture forces impact of surgeon ring and use conditions
    The Journal of Thoracic and Cardiovascular Surgery, 2018
    Co-Authors: Eric L Pierce, Joseph H Gorman, Robert C Gorman, Charles H Bloodworth, Andrew W Siefert, Thomas F Easley, Tetsushi Takayama, Tomonori Kawamura, Ajit P Yoganathan
    Abstract:

    Abstract Objective The study objective was to quantify the effect of ring type, ring-annulus sizing, suture position, and surgeon on the forces required to tie down and constrain a Mitral Annuloplasty ring to a beating heart. Methods Physio (Edwards Lifesciences, Irvine, Calif) or Profile 3D (Medtronic, Dublin, Ireland) Annuloplasty rings were instrumented with suture force transducers and implanted in ovine subjects (N = 23). Tie-down forces and cyclic contractile forces were recorded and analyzed at 10 suture positions and at 3 levels of increasing peak left ventricular pressure. Results Across all conditions, tie-down force was 2.7 ± 1.4 N and cyclic contractile force was 2.0 ± 1.2 N. Tie-down force was not meaningfully affected by any factor except surgeon. Significant differences in overall and individual tie-down forces were observed between the 2 primary implanting surgeons. No other factors were observed to significantly affect tie-down force. Contractile suture forces were significantly reduced by ring-annulus true sizing. This was driven almost exclusively by Physio cases and by reduction along the anterior aspect, where dehiscence is less common clinically. Contractile suture forces did not differ significantly between ring types. However, when undersizing, Profile 3D forces were significantly more uniform around the annular circumference. A suture's tie-down force did not correlate to its eventual contractile force. Conclusions Mitral Annuloplasty suture loading is influenced by ring type, ring-annulus sizing, suture position, and surgeon, suggesting that reports of dehiscence may not be merely a series of isolated errors. When compared with forces known to cause suture dehiscence, these in vivo suture loading data aid in establishing potential targets for reducing the occurrence of ring dehiscence.

  • suture forces in undersized Mitral Annuloplasty novel device and measurements
    The Annals of Thoracic Surgery, 2014
    Co-Authors: Andrew W Siefert, Satoshi Takebayashi, Chikashi Aoki, Morten O Jensen, Joseph H Gorman, Robert C Gorman, Eric L Pierce, Madonna E Lee, Joan Fernandez Esmerats, Ajit P Yoganathan
    Abstract:

    Purpose To demonstrate the first use of a novel technology for quantifying suture forces on Annuloplasty rings to better understand the mechanisms of ring dehiscence. Description Force transducers were developed, attached to a size 24 Physio ring, and implanted in the Mitral annulus of an ovine animal. Ring suture forces were measured after implantation and for cardiac cycles reaching peak left ventricular pressures (LVP) of 100, 125, and 150 mm Hg. Evaluation After implantation of the undersized ring to the flaccid annulus, the mean suture force was 2.0 ± 0.6 N. During cyclic contraction, the anterior ring suture forces were greater than the posterior ring suture forces at peak LVPs of 100 mm Hg (4.9 ± 2.0 N vs 2.1 ± 1.1 N), 125 mm Hg (5.4 ± 2.3 N vs 2.3 ± 1.2 N), and 150 mm Hg (5.7 ± 2.4 N vs 2.4 ± 1.1 N). The largest force was 7.4 N at 150 mm Hg. Conclusions The preliminary results demonstrate trends in Annuloplasty suture forces and their variation with location and LVP. Future studies will significantly contribute to clinical knowledge by elucidating the mechanisms of ring dehiscence while improving Annuloplasty ring design and surgical repair techniques.

  • quantitative evaluation of Annuloplasty on Mitral valve chordae tendineae forces to supplement surgical planning model development
    Cardiovascular Engineering and Technology, 2014
    Co-Authors: Andrew W Siefert, Karyn S. Kunzelman, Eric L Pierce, Jeanpierre Rabbah, Ajit P Yoganathan
    Abstract:

    Computational models of the heart’s Mitral valve (MV) exhibit potential for preoperative surgical planning in ischemic Mitral regurgitation (IMR). However challenges exist in defining boundary conditions to accurately model the function and response of the chordae tendineae to both IMR and surgical Annuloplasty repair. Towards this goal, a ground-truth data set was generated by quantifying the isolated effects of IMR and Mitral Annuloplasty on leaflet coaptation, regurgitation, and tethering forces of the anterior strut and posterior intermediary chordae tendineae. MVs were excised from ovine hearts (N = 15) and mounted in a pulsatile heart simulator which has been demonstrated to mimic the systolic MV geometry and coaptation of healthy and chronic IMR sheep. Strut and intermediary chordae from both MV leaflets (N = 4) were instrumented with force transducers. Tested conditions included a healthy control, IMR, oversized Annuloplasty, true-sized Annuloplasty, and undersized Mitral Annuloplasty. A2-P2 leaflet coaptation length, regurgitation, and chordal tethering were quantified and statistically compared across experimental conditions. MR was successfully simulated with significant increases in MR, tethering forces for each of the chordae, and decrease in leaflet coaptation (p < .05). Compared to the IMR condition, increasing levels of downsized Annuloplasty significantly reduced regurgitation, increased coaptation, reduced posteromedial papillary muscle strut chordal forces, and reduced intermediary chordal forces from the anterolateral papillary muscle (p < .05). These results provide for the first time a novel comprehensive data set for refining the ability of computational MV models to simulate IMR and varying sizes of complete rigid ring Annuloplasty.

Robert J M Klautz - One of the best experts on this subject based on the ideXlab platform.

  • long term effects of surgical ventricular restoration with additional restrictive Mitral Annuloplasty and or coronary artery bypass grafting on left ventricular function six month follow up by pressure volume loops
    The Journal of Thoracic and Cardiovascular Surgery, 2010
    Co-Authors: Ellen Ten A Brinke, Jeroen J Bax, Martin J Schalij, Robert J M Klautz, Sven A F Tulner, Ernst E Van Der Wall, Robert A E Dion, Michel I M Versteegh, Harriette F Verwey, Paul Steendijk
    Abstract:

    Objectives Previous studies demonstrated beneficial short-term effects of surgical ventricular restoration on mechanical dyssynchrony and left ventricular function and improved midterm and long-term clinical parameters. However, long-term effects on systolic and diastolic left ventricular function are still largely unknown. Methods We studied 9 patients with ischemic dilated cardiomyopathy who underwent surgical ventricular restoration with additional restrictive Mitral Annuloplasty and/or coronary artery bypass grafting. Invasive hemodynamic measurements by conductance catheter (pressure–volume loops) were obtained before and 6 months after surgery. In addition, New York Heart Association classification, quality-of-life score, and 6-minute hall-walk test were assessed. Results At 6 months' follow-up, all patients were alive and clinically in improved condition: New York Heart Association class from 3.3 ± 0.5 to 1.4 ± 0.7, quality-of-life score from 46 ± 22 to 15 ± 15, and 6-minute hall-walk test from 302 ± 123 to 444 ± 78 m (all P P  = .05), and left ventricular ejection fraction (36% ± 10% to 46% ± 10%; P P P P −1 ( P Conclusions Surgical ventricular restoration with additional restrictive Mitral Annuloplasty and/or coronary artery bypass grafting leads to sustained left ventricular volume reduction at 6 months' follow-up. We observed improved systolic function and unchanged early diastolic function but impaired passive diastolic properties. Clinical improvement, supported by decreased New York Heart Association class, improved quality-of-life score, and improved 6-minute hall-walk test may be related to improved systolic function, reduced mechanical dyssynchrony, and reduced wall stress.

  • predictors of Mitral regurgitation recurrence in patients with heart failure undergoing Mitral valve Annuloplasty
    American Journal of Cardiology, 2010
    Co-Authors: Agnieszka Ciarka, Victoria Delgado, Jeroen J Bax, Robert J M Klautz, Robert A E Dion, Jerry Braun, Michel I M Versteegh, Eric Boersma, Nico R Van De Veire
    Abstract:

    Restrictive Mitral Annuloplasty is a surgical treatment option for patients with heart failure (HF) and functional Mitral regurgitation (MR). However, recurrent MR has been reported at mid-term follow-up. The aim of the present study was to identify the echocardiographic predictors of recurrent MR in patients with HF undergoing Mitral Annuloplasty. During a mean follow-up of 2.6 ± 1.6 years, 109 patients with HF (49% ischemic and 51% idiopathic dilated cardiomyopathy) who had undergone Mitral valve repair were followed up (of 122 total patients). The severity of MR was quantified, and the following parameters were measured before intervention and at the mid-term follow-up examination: left ventricular (LV) and left atrial volumes and dimensions, LV sphericity index, Mitral annular area, and Mitral valve geometry parameters. At mid-term follow-up, 21 patients presented with significant MR (grade 2 to 4), and 88 patients had only MR grade 0 to 1. Both groups of patients had had a similar preoperative MR grade, Mitral annular area, and LV volume and dimension. In contrast, patients with recurrent MR had had increased preoperative posterior and anterior leaflet angles, tenting height, tenting area, and LV sphericity index compared to the patients without recurrent MR. Of the different parameters of Mitral and LV geometry, the distal Mitral anterior leaflet angle (hazard ratio 1.48, 95% confidence interval 1.32 to 1.66, p <0.001) and posterior leaflet angle (hazard ratio 1.13, 95% confidence interval 1.07 to 1.19, p <0.001) were independent determinants of MR at mid-term follow-up. In conclusion, in patients with HF of ischemic or idiopathic etiology and functional MR, distal Mitral leaflet tethering and posterior Mitral leaflet tethering were associated with recurrent MR after restrictive Mitral Annuloplasty.

  • restrictive Mitral Annuloplasty cures ischemic Mitral regurgitation and heart failure
    The Annals of Thoracic Surgery, 2008
    Co-Authors: Jerry Braun, Jeroen J Bax, Robert J M Klautz, Ernst E Van Der Wall, Eduard R Holman, Michel I M Versteegh, Eric Boersma, Nico R Van De Veire, Jos J M Westenberg, R Dion
    Abstract:

    Background Restrictive Mitral Annuloplasty with revascularization is considered the best approach to ischemic Mitral regurgitation with heart failure, but late results are controversial. We report late outcome in relation to preoperative left ventricular end-diastolic diameter (LVEDD) cutoff values, previously identified to predict intermediate-term left ventricular reverse remodeling. Methods One hundred consecutive ischemic Mitral regurgitation patients underwent restrictive Mitral Annuloplasty (stringent downsizing by two ring sizes; median size, 26) and coronary revascularization. Survivors were clinically and echocardiographically assessed at intermediate (18 months) and late (mean, 46 months) follow-up. Results Early mortality was 8%, and late mortality was 18%. Actuarial 1-, 3-, and 5-year survival rates were 87% ± 3.4%, 80% ± 4.1%, and 71% ± 5.1%. Mortality predictors (Cox regression) were preoperative inotropic support (hazard ratio, 6.2; 95% confidence interval, 2.3 to 16.9) and preoperative LVEDD greater than 65 mm (hazard ratio, 4.5; 95% confidence interval, 1.9 to 10.9). Five-year survival rate for patients with LVEDD of 65 mm or less was 80% ± 5.2%, versus 49% ± 11% for LVEDD greater than 65 mm ( p = 0.002). At 4.3 years' follow-up, New York Heart Association functional class had improved from 2.9 ± 0.8 to 1.6 ± 0.6 ( p Conclusions At 4.3 years' follow-up, intermediate-term cutoff values for left ventricular reverse remodeling proved to be predictors for late mortality. For patients with preoperative LVEDD of 65 mm or less, restrictive Mitral Annuloplasty with revascularization provides a cure for ischemic Mitral regurgitation and heart failure; however, when LVEDD exceeds 65 mm, outcome is poor and a ventricular approach should be considered.

  • surgical ventricular restoration in patients with ischemic dilated cardiomyopathy evaluation of systolic and diastolic ventricular function wall stress dyssynchrony and mechanical efficiency by pressure volume loops
    The Journal of Thoracic and Cardiovascular Surgery, 2006
    Co-Authors: Sven A F Tulner, Jeroen J Bax, Martin J Schalij, Robert J M Klautz, Paul Steendijk, Ernst E Van Der Wall, Robert A E Dion
    Abstract:

    Objectives: Surgical ventricular restoration aims at improving cardiac function by normalization of left ventricular shape and size. Recent studies indicate that surgical ventricular restoration is highly effective with an excellent 5-year outcome in patients with ischemic dilated cardiomyopathy. We used pressure-volume analysis to investigate acute changes in systolic and diastolic left ventricular function, mechanical dyssynchrony and efficiency, and wall stress. Methods: In 3 patient groups (total, n 33), pressure-volume loops were measured by conductance catheter before and after surgery. The main study group consisted of 10 patients with ischemic dilated cardiomyopathy (New York Heart Association class III/IV, left ventricular ejection fraction 30%) who had surgical ventricular restoration and coronary artery bypass grafting. In this group, 7 patients had additional restrictive Mitral Annuloplasty. To assess potential confounding effects of restrictive Mitral Annuloplasty and cardiopulmonary bypass, we included a group of 10 patients (New York Heart Association class III/IV, left ventricular ejection fraction 30%) who had isolated restrictive Mitral Annuloplasty and a group of 13 patients with preserved left ventricular function who had isolated coronary artery bypass grafting. Results: After surgical ventricular restoration, end-diastolic and end-systolic volumes were reduced from 211 54 to 169 34 mL (P .03) and from 147 41 to 110 59 mL (P .04), respectively. Left ventricular ejection fraction (from 27% 7% to 37% 13%, P .04) and end-systolic elastance (from 1.12 0.71 to 1.57 0.63 mm Hg/mL, P .03) improved. Peak wall stress (from 358 108 to 244 79 mm Hg, P .01) and mechanical dyssynchrony (from 26% 4% to 19% 6%, P .01) were reduced, whereas mechanical efficiency improved (from 0.34 13 to 0.49 0.14, P .03). End-diastolic pressure increased (from 13 6t o 20 5m m Hg,P .01), whereas the diastolic chamber stiffness constant tended to be increased (from 0.021 0.009 to 0.037 0.021 mL 1 , NS).

  • preoperative left ventricular dimensions predict reverse remodeling following restrictive Mitral Annuloplasty in ischemic Mitral regurgitation
    European Journal of Cardio-Thoracic Surgery, 2005
    Co-Authors: Jerry Braun, Jeroen J Bax, Robert J M Klautz, Eduard R Holman, Michel I M Versteegh, Eric Boersma, Pieter Voigt, Robert A E Dion
    Abstract:

    Objective: Ischemic Mitral regurgitation can be treated with a restrictive Mitral Annuloplasty, with or without coronary revascularization. In this study, the extent of reverse remodeling of the left ventricle following this strategy is assessed, as well as the factors that influence it. Methods: Eighty-seven consecutive patients with ischemic Mitral regurgitation and a mean ejection fraction of 32G10% underwent restrictive Mitral Annuloplasty (downsizing by two ring sizes, median ring size 26), with additional coronary revascularization in 75 patients. All underwent transthoracic echocardiography 18 months after surgery to assess residual Mitral regurgitation, Mitral valve gradient and left ventricular endsystolic and end-diastolic dimensions. Univariate and multivariate analysis was performed to identify predictors for reverse remodeling, defined as a 10% reduction in left ventricular dimension. Receiver-operating characteristic analysis was used to identify cut-off values for preoperative left ventricular dimensions in predicting reverse remodeling. Results: Early mortality was 8.0% (seven patients, three non-cardiac), late mortality was 7.5% (six patients, four non-cardiac). There were two reoperations (redo Annuloplasty), and four readmissions for heart failure. At 29 months follow-up, NYHA class improved from 3.0G0.9 to 1.3G0.5 (P!0.01). Mitral regurgitation grade decreased from 3.1G0.5 to 0.6G0.6 at 18 months, left ventricular end-systolic dimension decreased from 52G 8t o 44G11 mm (P!0.01), and end-diastolic dimension from 64G 8t o 58G10 mm (P!0.01). Multivariate analysis identified preoperative left ventricular end-diastolic dimension as the single best factor in predicting occurrence of reverse remodeling. For end-systolic dimension, 51 mm was the optimal cut-off value to predict reverse remodeling (specificity and sensitivity 81%, area under curve 0.85); for end-diastolic dimension, the cut-off value was 65 mm (specificity and sensitivity 89%, area under curve 0.92). Conclusions: Stringent restrictive Mitral Annuloplasty with or without revascularization provides excellent clinical results with acceptable mortality. At 18 months follow-up, there is no significant residual Mitral regurgitation. Reverse remodeling occurs in the majority of patients, but is limited by preoperative left ventricular dimensions. In patients with a left ventricular end-diastolic dimension exceeding 65 mm, additional surgical procedures are necessary to try and obtain reverse remodeling in this subgroup. q 2005 Elsevier B.V. All rights reserved.