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Entire Mitral Valve Reconstruction Using Porcine Extracellular Matrix: Adding a Ring Annuloplasty
Johannes H Jedrzejczyk1,2, Stine Krog3,4, Søren N Skov3,4
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.
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.
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