TY - JOUR
T1 - Releasable annuloplasty ring insertion - a novel experimental implantation model
AU - Bothe, Wolfgang
AU - Chang, Paul A.
AU - Swanson, Julia C.
AU - Itoh, Akinobu
AU - Arata, Koji
AU - Ingels, Neil B.
AU - Miller, David Craig
N1 - Funding Information:
§ Supported by grants HL-29589 and HL-67025 from the National Heart, Lung and Blood Institute. Dr Bothe was supported by the Deutsche Herzstiftung, Frankfurt, Germany. Dr Swanson was funded by Western States Affiliate American Heart Association Postdoctoral Fellowship. Dr Miller is a consultant for Medtronic Heart Valve Division Inc. * Corresponding author. Address: Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5247, USA. Tel.: +1 650 725 3826; fax: +1 650 725 3846. E-mail address: [email protected] (D.C. Miller).
PY - 2009/11
Y1 - 2009/11
N2 - Objective: Experimental testing of annuloplasty ring (AR) effects requires a control group if the AR is implanted conventionally. Our goal was to develop a reversible AR insertion method that allows for beating heart assessment with and without an AR, providing the ability to evaluate the effects of an AR in the same animal (internal control). We tested the feasibility of this technique in an in vivo ovine model using four-dimensional (4-D) radiopaque marker tracking. Methods: Before the operation, a rigid AR (Edwards Geoform®, Edwards Lifesciences, Irvine, CA, USA) was prepared by stitching the middle parts of eight double-armed sutures evenly spaced through the ring fabric using a Spring Eye needle. The resulting loops were 'locked' with polypropylene sutures. In addition, two drawstring sutures were attached to the AR. Using cardiopulmonary bypass and cardioplegic arrest, 12 adult sheep had 16 radiopaque markers sewn to the mitral annulus. The AR was implanted by stitching the eight sutures equidistantly in a perpendicular direction through the mitral annulus. The sheep were transferred to the catheterisation laboratory and 4-D marker coordinates were obtained using biplane videofluoroscopy (60 Hz) with the AR inserted (Geo-AR). The locking sutures were then released, the AR was pulled up to the atrial roof using the drawstring sutures and another dataset was acquired (control). Maximum and minimum mitral annular areas (MAAmax, MAAmin) during the cardiac cycle were derived from implanted markers. Data are provided from one representative animal. Results: AR insertion and release were uneventful in all animals. Whereas the mitral annulus was dynamic in the control state (MAAmax: 9.0 cm2, MAAmin: 7.8 cm2), mitral annular dynamics were abolished in the Geo-AR case (MAAmax: 6.2 cm2, MAAmin: 6.0 cm2). Conclusions: This novel releasable AR implantation method is feasible and permits in vivo assessment of AR effects in the same heart. The new technique should facilitate experimental AR testing and promote the development of ARs based on physical criteria.
AB - Objective: Experimental testing of annuloplasty ring (AR) effects requires a control group if the AR is implanted conventionally. Our goal was to develop a reversible AR insertion method that allows for beating heart assessment with and without an AR, providing the ability to evaluate the effects of an AR in the same animal (internal control). We tested the feasibility of this technique in an in vivo ovine model using four-dimensional (4-D) radiopaque marker tracking. Methods: Before the operation, a rigid AR (Edwards Geoform®, Edwards Lifesciences, Irvine, CA, USA) was prepared by stitching the middle parts of eight double-armed sutures evenly spaced through the ring fabric using a Spring Eye needle. The resulting loops were 'locked' with polypropylene sutures. In addition, two drawstring sutures were attached to the AR. Using cardiopulmonary bypass and cardioplegic arrest, 12 adult sheep had 16 radiopaque markers sewn to the mitral annulus. The AR was implanted by stitching the eight sutures equidistantly in a perpendicular direction through the mitral annulus. The sheep were transferred to the catheterisation laboratory and 4-D marker coordinates were obtained using biplane videofluoroscopy (60 Hz) with the AR inserted (Geo-AR). The locking sutures were then released, the AR was pulled up to the atrial roof using the drawstring sutures and another dataset was acquired (control). Maximum and minimum mitral annular areas (MAAmax, MAAmin) during the cardiac cycle were derived from implanted markers. Data are provided from one representative animal. Results: AR insertion and release were uneventful in all animals. Whereas the mitral annulus was dynamic in the control state (MAAmax: 9.0 cm2, MAAmin: 7.8 cm2), mitral annular dynamics were abolished in the Geo-AR case (MAAmax: 6.2 cm2, MAAmin: 6.0 cm2). Conclusions: This novel releasable AR implantation method is feasible and permits in vivo assessment of AR effects in the same heart. The new technique should facilitate experimental AR testing and promote the development of ARs based on physical criteria.
KW - Annuloplasty ring
KW - Novel insertion method
KW - Ovine model
KW - Reversible ring implantation
UR - http://www.scopus.com/inward/record.url?scp=70349973278&partnerID=8YFLogxK
U2 - 10.1016/j.ejcts.2009.06.028
DO - 10.1016/j.ejcts.2009.06.028
M3 - Article
C2 - 19646892
AN - SCOPUS:70349973278
SN - 1010-7940
VL - 36
SP - 830
EP - 832
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 5
ER -