Mathieu Vergnat, MD, Melissa M. Levack, MD, Benjamin M

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Presentation transcript:

The Effect of Surgical and Transcatheter Aortic Valve Replacement on Mitral Annular Anatomy Mathieu Vergnat, MD, Melissa M. Levack, MD, Benjamin M. Jackson, MD, Joseph E. Bavaria, MD, Howard C. Herrmann, MD, Albert T. Cheung, MD, Stuart J. Weiss, MD, PhD, Joseph H. Gorman, MD, Robert C. Gorman, MD The Annals of Thoracic Surgery Volume 95, Issue 2, Pages 614-619 (February 2013) DOI: 10.1016/j.athoracsur.2012.10.026 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Mitral valve segmentation. (A) Rotational template used for segmentation of the mitral valve annulus. Annular points are placed every 10 degrees on the two-dimensional long-axis view around the circumference of the annulus. (B) Segmentation of the anterior and posterior leaflets and coaptation is performed at 1-mm intervals along the length of the mitral valve. (AA = anterior annulus; AC = anterior commissure; AML = anterior mitral leaflet; AoV = aortic valve; LA = left atrium; LV = left ventricle; LVOT = left ventricular outflow tract; MVO = mitral valve orifice; PA = posterior annulus; PC = posterior commissure; PML = posterior mitral leaflet.) The Annals of Thoracic Surgery 2013 95, 614-619DOI: (10.1016/j.athoracsur.2012.10.026) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Illustrative example of geometric parameters. Mitral annular modeling depicting the measured parameters used for analysis. (A, B) Calculation of the annular height (AH) and septolateral diameter (SL). (C) Calculation for commissural width (CW) and mitral transverse diameter (MTD). (AC = anterior commissure; Mid-AA = mid anterior annulus; Mid-PA = mid posterior annulus; PC = posterior commissure.) The Annals of Thoracic Surgery 2013 95, 614-619DOI: (10.1016/j.athoracsur.2012.10.026) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Comparison of mitral regurgitation. Percentage of patients with varying degrees of mitral regurgitation before repair for each group (Pre), and the corresponding changes in severity of mitral regurgitation after aortic valve replacement (AVR) for each group (Post). No patients in either group experienced a worsening in the degree of mitral regurgitation. The Annals of Thoracic Surgery 2013 95, 614-619DOI: (10.1016/j.athoracsur.2012.10.026) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Representation of the eight mitral annular measured geometric indices evaluated and the corresponding difference before (Pre) and after (Post) aortic valve replacement (AVR). Geometric indices were similar between the transcatheter aortic valve replacement (TAVR) and the AVR groups before valve replacement; however, after intervention, patients who received a TAVR demonstrated relative preservation of annular geometry. Patients undergoing standard AVR demonstrated significant geometric deformation after valve replacement for a number of indices, indicated by *. Error bars = standard deviation. (A) Annular height (AH)*; (B) commissural width (CW); (C) annular height to commissural width ratio (AHCWR); (D) mitral valve transverse diameter (MVTD)*; (E) septolateral diameter (SL)*; (F) commissural width to septolateral diameter ratio (CWSLR); (G) mitral annular area (MAA)*; and (H) annular circumference. (Black lines = Sapien valve; gray lines = AVR.) The Annals of Thoracic Surgery 2013 95, 614-619DOI: (10.1016/j.athoracsur.2012.10.026) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) Comparison of select geometric indices in transcatheter aortic valve implantation (TAVI) versus aortic valve replacement (AVR). Patients undergoing AVR had significant decreases in annular height, septolateral diameter, and mitral annular area relative to their initial geometry. (B) Plot of annular height (AH) along the annular circumference. Annular height is preserved in TAVI after AVR but is notably decreased after standard AVR. *Denotes significance. (AC = anterior commissure; Mid-AA = mid anterior annulus; Mid-PA = mid posterior annulus; PC = posterior commissure.) The Annals of Thoracic Surgery 2013 95, 614-619DOI: (10.1016/j.athoracsur.2012.10.026) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions