Democratizing Mitral Valve Repair Through the use of a Novel Annuloplasty Ring
Presented During:
Friday, May 5, 2023: 7:15AM - 7:20AM
New York Hilton Midtown
Posted Room Name:
Petit Trianon
Abstract No:
MO059
Submission Type:
Abstract Submission
Authors:
Benjamin Seadler (1), David Joyce (2), James Zelten (3), Kevin Sweeney (4), Taylor Wisgerhof (4), Brandon Tefft (3), Paul Pearson (5)
Institutions:
(1) Medical College of Wisconsin Department of Surgery, Milwaukee, WI, (2) N/A, N/A, (3) The Medical College of Wisconsin, Milwaukee, WI, (4) Resolution Medical, Minneapolis, MN, (5) N/A, Wheaton, IL
Submitting Author:
Benjamin Seadler
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Medical College of Wisconsin Department of Surgery
Medical College of Wisconsin Department of Surgery
Co-Author(s):
David Joyce
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James Zelten
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The Medical College of Wisconsin
The Medical College of Wisconsin
Kevin Sweeney
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Resolution Medical
Resolution Medical
Taylor Wisgerhof
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Resolution Medical
Resolution Medical
Brandon Tefft
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The Medical College of Wisconsin
The Medical College of Wisconsin
Paul Pearson
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N/A
Presenting Author:
David Joyce
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Abstract:
Objectives
Despite the well-documented benefits of mitral valve repair in the setting of degenerative disease, up to 50% of patients treated in the general cardiac surgical community undergo replacement techniques, compared with repair rates of 95-100% in the hands of experienced surgeons. Innovation in annuloplasty ring design carries the potential to expand the benefits of mitral repair to communities in which mitral expertise or case volumes are limited. The objective of this study was to assess the efficacy of a simplified mitral valve repair ring prior to conducting animal studies.
Methods
A novel mitral annuloplasty ring was designed in which microporous, monofilament sutures were attached to a semirigid complete annuloplasty ring with a polyester double-velour cuff in a crosshatch pattern with 2.5 mm spacing. A LifeTec Cardiac BioSimulator platform (Resolution Medical, Fridley, MN) was used in which severe regurgitation was introduced through transection of the chordae attached to the P2 segment of the mitral valve in six porcine hearts. Pressure monitoring of the left atrium and aorta, epicardial echocardiographic assessment, and videographic monitoring of the atrial and ventricular side of the mitral valve confirmed the degree of regurgitation.
Results
In all six porcine hearts, competency of the valve was confirmed following repair both via echocardiographic and videographic assessment. (Figure) Mean left atrial pressures (mmHg) increased from 24±1.6 at baseline to 36±4.1 (P=0.0003) following chordal transection, correcting to 29±4.6 (P=0.02) following repair. Mean aortic pressures (mmHg) decreased from 62±4.0 at baseline to 53±4.0 (P=0.002) following chordal transection, correcting to 60±10.4 (P=0.1) following repair. Mean cardiac output (L/min) decreased from 4.8±0.2 at baseline to 4.1±0.2 (P=0.002) following chordal transection, correcting to 4.7±0.5 (P=0.04) following repair.
Conclusions
Preservation of the coaptation plane through a crosshatch suture grid mounted to an annuloplasty ring restored mitral valve competency with no evidence of clinically significant residual regurgitation in a high-fidelity biosimulator. This novel design carries the potential for greater simplification in mitral valve repair techniques. These findings support the utility of chronic animal studies to establish freedom from thrombosis, hemolysis, and new onset mitral stenosis.
Despite the well-documented benefits of mitral valve repair in the setting of degenerative disease, up to 50% of patients treated in the general cardiac surgical community undergo replacement techniques, compared with repair rates of 95-100% in the hands of experienced surgeons. Innovation in annuloplasty ring design carries the potential to expand the benefits of mitral repair to communities in which mitral expertise or case volumes are limited. The objective of this study was to assess the efficacy of a simplified mitral valve repair ring prior to conducting animal studies.
Methods
A novel mitral annuloplasty ring was designed in which microporous, monofilament sutures were attached to a semirigid complete annuloplasty ring with a polyester double-velour cuff in a crosshatch pattern with 2.5 mm spacing. A LifeTec Cardiac BioSimulator platform (Resolution Medical, Fridley, MN) was used in which severe regurgitation was introduced through transection of the chordae attached to the P2 segment of the mitral valve in six porcine hearts. Pressure monitoring of the left atrium and aorta, epicardial echocardiographic assessment, and videographic monitoring of the atrial and ventricular side of the mitral valve confirmed the degree of regurgitation.
Results
In all six porcine hearts, competency of the valve was confirmed following repair both via echocardiographic and videographic assessment. (Figure) Mean left atrial pressures (mmHg) increased from 24±1.6 at baseline to 36±4.1 (P=0.0003) following chordal transection, correcting to 29±4.6 (P=0.02) following repair. Mean aortic pressures (mmHg) decreased from 62±4.0 at baseline to 53±4.0 (P=0.002) following chordal transection, correcting to 60±10.4 (P=0.1) following repair. Mean cardiac output (L/min) decreased from 4.8±0.2 at baseline to 4.1±0.2 (P=0.002) following chordal transection, correcting to 4.7±0.5 (P=0.04) following repair.
Conclusions
Preservation of the coaptation plane through a crosshatch suture grid mounted to an annuloplasty ring restored mitral valve competency with no evidence of clinically significant residual regurgitation in a high-fidelity biosimulator. This novel design carries the potential for greater simplification in mitral valve repair techniques. These findings support the utility of chronic animal studies to establish freedom from thrombosis, hemolysis, and new onset mitral stenosis.
Mitral Conclave:
From Bench to Bedside: Mitral Valve Research
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