Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional–printed left heart simulatorCentral MessagePerspective
Objective: Mitral valve repair is the gold standard treatment for degenerative mitral regurgitation; however, a multitude of repair techniques exist with little quantitative data comparing these approaches. Using a novel ex vivo model, we sought to evaluate biomechanical differences between repair t...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-12-01
|
| Series: | JTCVS Techniques |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250721006714 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849399206209388544 |
|---|---|
| author | Michael J. Paulsen, MD Mateo Marin Cuartas, MD Annabel Imbrie-Moore, MS Hanjay Wang, MD Robert Wilkerson, BS Justin Farry, BSE Yuanjia Zhu, MD Michael Ma, MD John W. MacArthur, MD Y. Joseph Woo, MD |
| author_facet | Michael J. Paulsen, MD Mateo Marin Cuartas, MD Annabel Imbrie-Moore, MS Hanjay Wang, MD Robert Wilkerson, BS Justin Farry, BSE Yuanjia Zhu, MD Michael Ma, MD John W. MacArthur, MD Y. Joseph Woo, MD |
| author_sort | Michael J. Paulsen, MD |
| collection | DOAJ |
| description | Objective: Mitral valve repair is the gold standard treatment for degenerative mitral regurgitation; however, a multitude of repair techniques exist with little quantitative data comparing these approaches. Using a novel ex vivo model, we sought to evaluate biomechanical differences between repair techniques. Methods: Using porcine mitral valves mounted within a custom 3-dimensional–printed left heart simulator, we induced mitral regurgitation using an isolated P2 prolapse model by cutting primary chordae. Next, we repaired the valves in series using the edge-to-edge technique, neochordoplasty, nonresectional remodeling, and classic leaflet resection. Hemodynamic data and chordae forces were measured and analyzed using an incomplete counterbalanced repeated measures design with the healthy pre-prolapse valve as a control. Results: With the exception of the edge-to-edge technique, all repair methods effectively corrected mitral regurgitation, returning regurgitant fraction to baseline levels (baseline 11.9% ± 3.7%, edge-to-edge 22.5% ± 6.9%, nonresectional remodeling 12.3% ± 3.0%, neochordal 13.4% ± 4.8%, resection 14.7% ± 5.5%, P < 0.01). Forces on the primary chordae were minimized using the neochordal and nonresectional techniques whereas the edge-to-edge and resectional techniques resulted in significantly elevated primary forces. Secondary chordae forces also followed this pattern, with edge-to-edge repair generating significantly higher secondary forces and leaflet resection trending higher than the nonresectional and neochord repairs. Conclusions: Although multiple methods of degenerative mitral valve repair are used clinically, their biomechanical properties vary significantly. Nonresectional techniques, including leaflet remodeling and neochordal techniques, appear to result in lower chordal forces in this ex vivo technical engineering model. |
| format | Article |
| id | doaj-art-ebc4d5f820e04352aeb3739ccf427146 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-ebc4d5f820e04352aeb3739ccf4271462025-08-20T03:38:23ZengElsevierJTCVS Techniques2666-25072021-12-011024425110.1016/j.xjtc.2021.09.040Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional–printed left heart simulatorCentral MessagePerspectiveMichael J. Paulsen, MD0Mateo Marin Cuartas, MD1Annabel Imbrie-Moore, MS2Hanjay Wang, MD3Robert Wilkerson, BS4Justin Farry, BSE5Yuanjia Zhu, MD6Michael Ma, MD7John W. MacArthur, MD8Y. Joseph Woo, MD9Department of Cardiothoracic Surgery, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Mechanical Engineering, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif; Address for reprints: Y. Joseph Woo, MD, Department of Cardiothoracic Surgery, Department of Bioengineering, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Dr, Stanford, CA 94305-5407.Objective: Mitral valve repair is the gold standard treatment for degenerative mitral regurgitation; however, a multitude of repair techniques exist with little quantitative data comparing these approaches. Using a novel ex vivo model, we sought to evaluate biomechanical differences between repair techniques. Methods: Using porcine mitral valves mounted within a custom 3-dimensional–printed left heart simulator, we induced mitral regurgitation using an isolated P2 prolapse model by cutting primary chordae. Next, we repaired the valves in series using the edge-to-edge technique, neochordoplasty, nonresectional remodeling, and classic leaflet resection. Hemodynamic data and chordae forces were measured and analyzed using an incomplete counterbalanced repeated measures design with the healthy pre-prolapse valve as a control. Results: With the exception of the edge-to-edge technique, all repair methods effectively corrected mitral regurgitation, returning regurgitant fraction to baseline levels (baseline 11.9% ± 3.7%, edge-to-edge 22.5% ± 6.9%, nonresectional remodeling 12.3% ± 3.0%, neochordal 13.4% ± 4.8%, resection 14.7% ± 5.5%, P < 0.01). Forces on the primary chordae were minimized using the neochordal and nonresectional techniques whereas the edge-to-edge and resectional techniques resulted in significantly elevated primary forces. Secondary chordae forces also followed this pattern, with edge-to-edge repair generating significantly higher secondary forces and leaflet resection trending higher than the nonresectional and neochord repairs. Conclusions: Although multiple methods of degenerative mitral valve repair are used clinically, their biomechanical properties vary significantly. Nonresectional techniques, including leaflet remodeling and neochordal techniques, appear to result in lower chordal forces in this ex vivo technical engineering model.http://www.sciencedirect.com/science/article/pii/S2666250721006714biomechanicschordae forcesex vivo modelleaflet remodelingleaflet resectionmitral valve repair |
| spellingShingle | Michael J. Paulsen, MD Mateo Marin Cuartas, MD Annabel Imbrie-Moore, MS Hanjay Wang, MD Robert Wilkerson, BS Justin Farry, BSE Yuanjia Zhu, MD Michael Ma, MD John W. MacArthur, MD Y. Joseph Woo, MD Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional–printed left heart simulatorCentral MessagePerspective JTCVS Techniques biomechanics chordae forces ex vivo model leaflet remodeling leaflet resection mitral valve repair |
| title | Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional–printed left heart simulatorCentral MessagePerspective |
| title_full | Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional–printed left heart simulatorCentral MessagePerspective |
| title_fullStr | Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional–printed left heart simulatorCentral MessagePerspective |
| title_full_unstemmed | Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional–printed left heart simulatorCentral MessagePerspective |
| title_short | Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional–printed left heart simulatorCentral MessagePerspective |
| title_sort | biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3 dimensional printed left heart simulatorcentral messageperspective |
| topic | biomechanics chordae forces ex vivo model leaflet remodeling leaflet resection mitral valve repair |
| url | http://www.sciencedirect.com/science/article/pii/S2666250721006714 |
| work_keys_str_mv | AT michaeljpaulsenmd biomechanicalengineeringcomparisonoffourleafletrepairtechniquesformitralregurgitationusinganovel3dimensionalprintedleftheartsimulatorcentralmessageperspective AT mateomarincuartasmd biomechanicalengineeringcomparisonoffourleafletrepairtechniquesformitralregurgitationusinganovel3dimensionalprintedleftheartsimulatorcentralmessageperspective AT annabelimbriemoorems biomechanicalengineeringcomparisonoffourleafletrepairtechniquesformitralregurgitationusinganovel3dimensionalprintedleftheartsimulatorcentralmessageperspective AT hanjaywangmd biomechanicalengineeringcomparisonoffourleafletrepairtechniquesformitralregurgitationusinganovel3dimensionalprintedleftheartsimulatorcentralmessageperspective AT robertwilkersonbs biomechanicalengineeringcomparisonoffourleafletrepairtechniquesformitralregurgitationusinganovel3dimensionalprintedleftheartsimulatorcentralmessageperspective AT justinfarrybse biomechanicalengineeringcomparisonoffourleafletrepairtechniquesformitralregurgitationusinganovel3dimensionalprintedleftheartsimulatorcentralmessageperspective AT yuanjiazhumd biomechanicalengineeringcomparisonoffourleafletrepairtechniquesformitralregurgitationusinganovel3dimensionalprintedleftheartsimulatorcentralmessageperspective AT michaelmamd biomechanicalengineeringcomparisonoffourleafletrepairtechniquesformitralregurgitationusinganovel3dimensionalprintedleftheartsimulatorcentralmessageperspective AT johnwmacarthurmd biomechanicalengineeringcomparisonoffourleafletrepairtechniquesformitralregurgitationusinganovel3dimensionalprintedleftheartsimulatorcentralmessageperspective AT yjosephwoomd biomechanicalengineeringcomparisonoffourleafletrepairtechniquesformitralregurgitationusinganovel3dimensionalprintedleftheartsimulatorcentralmessageperspective |