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Related Experiment Video

Updated: Jun 4, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

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Published on: December 11, 2017

Entire Mitral Valve Reconstruction Using Porcine Extracellular Matrix: Adding a Ring Annuloplasty.

Johannes H Jedrzejczyk^1,2, Stine Krog^3,4, Søren N Skov^3,4

¹Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Århus, Denmark. johjed@clin.au.dk.

Cardiovascular Engineering and Technology

|March 20, 2024

Summary

Adding a flexible annuloplasty ring to mitral valve reconstruction using CorMatrix® altered the valve shape, causing regurgitation. Researchers do not recommend this combination, suggesting further investigation for suitable annuloplasty devices.

Keywords:

2-Ply small intestinal submucosa extracellular matrix Annuloplasty ring Mitral valve Mitral valve reconstruction Mitral valve repair Mitral valve replacement

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Published on: May 26, 2023

Area of Science:

Biomaterials Science
Cardiovascular Surgery
Medical Devices

Background:

Mitral valve reconstruction presents challenges in restoring physiological function.
Extracellular matrix (ECM) grafts, like CorMatrix®, offer potential for valve repair.
Annuloplasty rings aim to stabilize the valve annulus during the cardiac cycle.

Purpose of the Study:

To investigate the impact of a flexible annuloplasty ring on mitral valve geometry and dynamics after reconstruction with a CorMatrix® graft in a porcine model.
To assess the compatibility of a Simulus® flexible ring with CorMatrix® mitral valve reconstruction.

Main Methods:

Acute porcine model (n=8) with self-control design.
Complete mitral valve reconstruction using 2-ply small intestinal submucosa ECM (CorMatrix®) tube graft.
Insertion of a Simulus® flexible annuloplasty ring post-reconstruction.
Characterization via sonomicrometry and echocardiography, focusing on annular geometry and valvular dynamics.

Main Results:

Annuloplasty ring insertion maintained more constant in-plane annular dynamics compared to reconstruction alone.
Significant decrease in commissure-commissure distance (35.0±3.4 mm vs. 27.4±1.9 mm, P<0.001) after ring insertion.
Shift from physiological D-shape to circular annulus, causing leaflet coaptation folds and a central regurgitant jet.

Conclusions:

Successful mitral valve reconstruction using CorMatrix® combined with flexible annuloplasty was achieved.
Annuloplasty reduced unphysiological systolic widening but altered annular shape.
The Simulus flex ring is not recommended with this technique due to adverse leaflet coaptation and regurgitation; further research for suitable annuloplasty is needed.