Key result
Virtual mitral valve sizing by different anatomical parameters yields significantly different annuloplasty ring size selections.
Why the study?
Ring sizing for mitral valve annuloplasty is conventionally done intraoperatively with variable strategies among surgeons, leading to poor reproducibility.
Do different sizing strategies lead to different selected annuloplasty ring sizes in patients undergoing mitral valve repair?
Observational (n=43)
No
Do different sizing strategies lead to different selected annuloplasty ring sizes in patients undergoing mitral valve repair?
p-value: p=≤0.01
Different routinely applied annuloplasty sizing strategies lead to the selection of significantly different ring sizes, highlighting ambiguity in current sizing methods.
Different sizing methods yield inconsistent rings in mitral repair; leaves open need for standardized, validated approaches.
BACKGROUND: Ring sizing for mitral valve annuloplasty is conventionally done intraoperatively using specific 'sizer' instruments, which are placed onto the valve tissue. This approach is barely reproducible since different sizing strategies have been established among surgeons. The goal of this study is to virtually apply different sizing methods on the basis of pre-repair echocardiography to find out basic differences between sizing strategies. METHODS: In three-dimensional echocardiographs of 43 patients, the mitral annulus and the contour of the anterior mitral leaflet were segmented using MITK Mitralyzer software. Similarly, three-dimensional virtual models of Carpentier-Edwards Physio II annuloplasty rings and their corresponding sizers were interactively generated from computer tomography images. For each patient, the matching annuloplasty ring was selected repeatedly according to popular sizing strategies, such as the height of anterior mitral leaflet, the intercommissural distance and the surface area of anterior mitral leaflet. The areas of the selected rings were considered as the neo-surface area of the mitral annulus after implantation. RESULTS: The sizing of the mitral valve according to the height of anterior mitral leaflet (mean ring size = 29.9 ± 3.90), intercommissural distance (mean ring size = 37.5 ± 1.92) or surface area of anterior mitral leaflet (mean ring size = 32.7 ± 3.3) led to significantly different measurements (p ≤ 0.01). In contrary to intercommissural distance, height and surface area of the anterior mitral leaflet exhibited significant variations between the patients (p ≤ 0.01). The sizing according to the height of anterior mitral leaflet led to the maximal reduction of the mitral annulus surface area followed by the sizing according to the surface area of anterior mitral leaflet and finally by the intercommissural distance. CONCLUSIONS: This novel comprehensive computer-based analysis reveals that the surveyed sizing methods led to the selection of significantly different annuloplasty rings and therefore underscore the ambiguity of routinely applied annuloplasty sizing strategies.
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Al‐Maisary et al. (2017) conducted an observational in Mitral valve insufficiency (n=43). Virtual mitral annuloplasty ring sizing methods vs. Comparison between methods (AML height, intercommissural distance, AML surface area) was evaluated on Selected annuloplasty ring size (p=≤0.01). Virtual sizing of the mitral valve according to anterior mitral leaflet height, intercommissural distance, or anterior mitral leaflet surface area led to significantly different ring size selections (p≤0.01).
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