A Novel Technique for Measuring Mitral Valve Coaptation Height Using Fiberscope Technology: A Developing Approach for Intraoperative Evaluation of Mitral Valve Repair
Presented During:
Friday, May 5, 2023: 7:20AM - 7:25AM
New York Hilton Midtown
Posted Room Name:
Petit Trianon
Abstract No:
MO060
Submission Type:
Abstract Submission
Authors:
Dominic Recco (1), Nicholas Kneier (2), Patrick Earley (3), Shannen Kizilski (3), Peter Hammer (3), David Hoganson (3)
Institutions:
(1) Boston Children's Hospital, Boston, MA, United States, (2) Boston Children’s Hospital, Boston, MA, (3) Boston Children's Hospital, Boston, MA
Submitting Author:
Dominic Recco
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Boston Children's Hospital
Boston Children's Hospital
Co-Author(s):
Nicholas Kneier
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Boston Children’s Hospital
Boston Children’s Hospital
Patrick Earley
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Boston Children's Hospital
Boston Children's Hospital
Shannen Kizilski
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Boston Children's Hospital
Boston Children's Hospital
Peter Hammer
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Boston Children's Hospital
Boston Children's Hospital
*David Hoganson
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Boston Children's Hospital
Boston Children's Hospital
Presenting Author:
Dominic Recco
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Abstract:
Objective: MV repair is the standard treatment for MR. Restoring adequate coaptation height is a key principle of MV repair. Quantitative assessment of MV coaptation remains challenging, with no reliable method available for intraoperative use prior to discontinuing CPB. This study aimed to evaluate the utility of fiberscope (FS) technology to assess MV coaptation height for intraoperative use.
Methods: Ex vivo testing was performed on 3 adult porcine hearts. The LA was resected, leaving ~3mm of atrium above the MV annulus. The LV was pressurized through the aorta to 26.8±1mmHg. A 4mm endoscope was inserted into the LV apex, centered under the MV orifice, and secured by purse-strings. A FS system, consisting of a Milliscope II camera and 0.7mm diameter x 15cm long 90° semi-rigid scope, with 1.2mm focal length (Zibra Corp, Westport, MA), was mounted above the MV annulus in a 3D-printed fixture that enabled orthogonal placement of the device and attachment of calipers for real-time measurements. Two locations on each MV A2 and P2 segments were selected by LV endoscopic evaluation of the MV leaflets and chordae attachments. Three measurements at each location, from the top of coaptation to the leaflet edge, were recorded using the FS. In blinded fashion, the FS was used to identify the leaflet edge. Accuracy was verified using the endoscope. A control (metal rod of similar thickness) was used for comparison, with leaflet length recorded when the control was seen in the LV with the apical endoscope. The FS vs control methods were compared.
Results: Coaptation measurements were similar for the control and FS methods across all hearts at the A2 and P2 locations (A2 11.5±1.1mm control vs 11.3±0.8mm FS; P2 11.5±1.5mm control vs 11.7±2.1mm FS). Both methods had similar variability across the three measurements taken at each leaflet segment location (control SD 0.09-0.95mm and FS SD 0.03-0.90mm). One outlier was excluded from analysis (n=11/12). The difference between measurement methods was less than 1.1mm with a median absolute difference of 0.46 (0.20-0.88)mm. Percent error between measurement methods was less than 8% with a median absolute percent error of 4.03 (1.68-7.57)%.
Conclusions: Utilization of a miniaturized FS enabled precise and accurate quantification of MV coaptation. This novel technique is promising for evaluating post-repair valve competence and coaptation height. Further study and validation in vivo are necessary prior to intraoperative use.
Methods: Ex vivo testing was performed on 3 adult porcine hearts. The LA was resected, leaving ~3mm of atrium above the MV annulus. The LV was pressurized through the aorta to 26.8±1mmHg. A 4mm endoscope was inserted into the LV apex, centered under the MV orifice, and secured by purse-strings. A FS system, consisting of a Milliscope II camera and 0.7mm diameter x 15cm long 90° semi-rigid scope, with 1.2mm focal length (Zibra Corp, Westport, MA), was mounted above the MV annulus in a 3D-printed fixture that enabled orthogonal placement of the device and attachment of calipers for real-time measurements. Two locations on each MV A2 and P2 segments were selected by LV endoscopic evaluation of the MV leaflets and chordae attachments. Three measurements at each location, from the top of coaptation to the leaflet edge, were recorded using the FS. In blinded fashion, the FS was used to identify the leaflet edge. Accuracy was verified using the endoscope. A control (metal rod of similar thickness) was used for comparison, with leaflet length recorded when the control was seen in the LV with the apical endoscope. The FS vs control methods were compared.
Results: Coaptation measurements were similar for the control and FS methods across all hearts at the A2 and P2 locations (A2 11.5±1.1mm control vs 11.3±0.8mm FS; P2 11.5±1.5mm control vs 11.7±2.1mm FS). Both methods had similar variability across the three measurements taken at each leaflet segment location (control SD 0.09-0.95mm and FS SD 0.03-0.90mm). One outlier was excluded from analysis (n=11/12). The difference between measurement methods was less than 1.1mm with a median absolute difference of 0.46 (0.20-0.88)mm. Percent error between measurement methods was less than 8% with a median absolute percent error of 4.03 (1.68-7.57)%.
Conclusions: Utilization of a miniaturized FS enabled precise and accurate quantification of MV coaptation. This novel technique is promising for evaluating post-repair valve competence and coaptation height. Further study and validation in vivo are necessary prior to intraoperative use.
Mitral Conclave:
Mitral Repair Techniques & Strategies
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