The geoform disease-specific annuloplasty system: A finite element study
The geoform disease-specific annuloplasty system: A finite element study
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DOI：
10.1016/j.athoracsur.2007.03.040
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发表时间：
2007-07-01
影响因子：
4.6
通讯作者：
Redaelli, Alberto
中科院分区：
文献类型：
--
作者：
Votta, Emiliano;Maisano, Francesco;Redaelli, Alberto
背景。功能性二尖瓣返流（FMR）是由于功能和几何因素的结合而导致二尖瓣瓣瓣无法覆盖。瓣膜功能通常通过小尺寸环成形术来恢复，减少原有环的前后尺寸。在严重FMR的情况下，这种解决方案可能是不够的。使用特异性环校正FMR可能会获得更好的结果。Geoform环是最近设计的fmr专用假体，其性能与标准Physio环形成形术环进行了比较。采用有限元模型模拟扩张型心肌病相关FMR，并比较在收缩峰值时瓣膜的病理状况与两种装置对应的术后情况。三个程度的病理模拟渐进式移位乳头状肌顶端，高达5毫米。模拟了三种环尺寸。评估了反流面积、配合长度和作用于阀门结构的应力。在对Geoform的使用进行建模时，覆盖长度总是大于7 mm。在最不利的情况下，与基线相比，反流面积减少了74%，当模拟缩小尺寸时，小叶应力减少了20%。模拟Physio环植入时，覆盖长度最大可达4.3 mm，最大反流面积减少60%，小叶应力减少。特定疾病的假体可能允许恢复瓣膜功能，即使是严重程度的小叶栓系，避免了积极缩小的需要，从而导致更持久的结果。
Background. Functional mitral regurgitation (FMR) is the inability of mitral leaflets to coapt due to a combination of functional and geometrical factors. Valve competence is commonly restored by undersized annuloplasty, reducing the native annulus anteroposterior dimension. In case of severe FMR, this solution may be inadequate. The use of rings specific for the correction of FMR may lead to better results.Methods. The performance of the Geoform ring, a recently designed FMR-specific prosthesis, was compared with that of a standard Physio annuloplasty ring. Finite element modeling was used to simulate dilated cordiomyopathy-related FMR and compare, at the systolic peak, the valve's pathologic condition with the postoperative scenario corresponding to both devices. Three degrees of the pathology were simulated by progressively displacing papillary muscles apically, up to 5 mm. Three ring sizes were modeled.Results. Regurgitant area, coaptation length, and stresses acting on valve structures were assessed. When the use of the Geoform was modeled, coaptation length was always longer than 7 mm. In the most unfavorable case, the regurgitant area reduction was 74% with respect to baseline, and leaflets stresses were reduced by 20% when undersizing was simulated. When Physio ring implantation was simulated, coaptation length maximum extent was equal to 4.3 mm, the maximum regurgitant area reduction was equal to 60%, and leaflet stress reduction was observed.Conclusions. Disease-specific prostheses may allow for restoration of valve competence even for significant degrees of leaflets tethering and avoid the need for aggressive undersizing, thus leading to more durable results.