MO59. Democratizing Mitral Valve Repair Through the use of a Novel Annuloplasty Ring
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Dr. David Joyce is a Distinguished Graduate of the United States Air Force Academy. He received his medical degree from Harvard and completed General Surgery training at the Johns Hopkins Hospital, during which time he spent two years working in the research lab of Dr. Michael DeBakey at the Texas Medical Center. He completed his Cardiothoracic Surgery training at Stanford and served as a Senior Associate Consultant at the Mayo Clinic, before taking on the role of Surgical Director for Heart and Lung Transplantation at the Medical College of Wisconsin. As Professor in Surgery, Dr. Joyce is a member of the editorial board for the Journal of Thoracic and Cardiovascular Surgery as well as author to over 100 peer reviewed manuscripts and editor of the leading textbook on Mechanical Circulatory Support. He currently serves as the Medical Director for Thoracic and Cardiovascular Surgery at the East Idaho Regional Medical Center. Dr. Joyce completed an Executive MBA at the University of Chicago Booth School of Business where he studied negotiation and persuasion–skills which he credits for his successful marriage proposal to Dr. Joyce Sanchez, an infectious disease specialist who is also employed with HCA Healthcare in Idaho Falls. When he’s not performing complex cardiac surgical procedures, he enjoys chasing his two children down the terrain parks of the mountain west.
Description
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.