Mitral valve posterior leaflet reconstruction using extracellular matrix: an acute porcine study

Marcell J Tjørnild; Søren N Skov; Karen B Poulsen; Mona Sharghbin; Leila L Benhassen; Lisa Carlson Hanse; Farhad Waziri; Diana M Røpcke; Sten L Nielsen; J Michael Hasenkam

doi:10.1093/ejcts/ezy152

Mitral valve posterior leaflet reconstruction using extracellular matrix: an acute porcine study

Marcell J Tjørnild, Søren N Skov, Karen B Poulsen, Mona Sharghbin, Leila L Benhassen, Lisa Carlson Hanse, Farhad Waziri, Diana M Røpcke, Sten L Nielsen, J Michael Hasenkam

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

9 Citationer (Scopus)

Abstract

OBJECTIVES: To investigate mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet.

METHODS: Mitral valve posterior leaflet and subvalvular reconstruction was characterized in an acute 80-kg porcine model with 7 pigs acting as their own controls. The characterization was based on pressure catheter measurements of pressure differences to identify mitral regurgitation, stenosis and systolic anterior motion. Furthermore, echocardiography was used for the evaluation of leaflet mobility and geometry, whereas sonomicrometry was used to describe annular and subvalvular geometry.

RESULTS: The reconstructed mitral valve was fully functional without any signs of regurgitation (peak left atrial pressure for baseline and reconstruction 12 ± 2 mmHg vs 11 ± 2 mmHg, P = 0.550), mitral valve stenosis (mean pressure difference across the mitral valve 4.8 ± 2.3 mmHg vs 4.1 ± 2.3 mmHg, P = 0.589) or systolic anterior motion. The echocardiographic characterization revealed septal-lateral downsizing, reduced tenting area, increased coaptation length (6.0 ± 0.6 mm vs 8.7 ± 2.3 mm, P = 0.002) and an atrial bend of the reconstructed posterior leaflet. A ballooning effect of the patch material was present at the posterior annular segment.

CONCLUSIONS: Mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet as patch material was possible in an acute porcine model. The reconstructed mitral valve was fully functional without signs of mitral valve stenosis, valve regurgitation, stenosis or systolic anterior motion. The ballooning appearance of the patch material might, however, constitute an altered leaflet stress distribution in this area.

Originalsprog	Engelsk
Tidsskrift	European Journal of Cardio-Thoracic Surgery
Vol/bind	54
Nummer	5
Sider (fra-til)	832-840
Antal sider	9
ISSN	1010-7940
DOI	https://doi.org/10.1093/ejcts/ezy152
Status	Udgivet - 2018

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10.1093/ejcts/ezy152

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@article{b6923b0d82f84f10a8ed520b919925ea,

title = "Mitral valve posterior leaflet reconstruction using extracellular matrix: an acute porcine study",

abstract = "OBJECTIVES: To investigate mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet.METHODS: Mitral valve posterior leaflet and subvalvular reconstruction was characterized in an acute 80-kg porcine model with 7 pigs acting as their own controls. The characterization was based on pressure catheter measurements of pressure differences to identify mitral regurgitation, stenosis and systolic anterior motion. Furthermore, echocardiography was used for the evaluation of leaflet mobility and geometry, whereas sonomicrometry was used to describe annular and subvalvular geometry.RESULTS: The reconstructed mitral valve was fully functional without any signs of regurgitation (peak left atrial pressure for baseline and reconstruction 12 ± 2 mmHg vs 11 ± 2 mmHg, P = 0.550), mitral valve stenosis (mean pressure difference across the mitral valve 4.8 ± 2.3 mmHg vs 4.1 ± 2.3 mmHg, P = 0.589) or systolic anterior motion. The echocardiographic characterization revealed septal-lateral downsizing, reduced tenting area, increased coaptation length (6.0 ± 0.6 mm vs 8.7 ± 2.3 mm, P = 0.002) and an atrial bend of the reconstructed posterior leaflet. A ballooning effect of the patch material was present at the posterior annular segment.CONCLUSIONS: Mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet as patch material was possible in an acute porcine model. The reconstructed mitral valve was fully functional without signs of mitral valve stenosis, valve regurgitation, stenosis or systolic anterior motion. The ballooning appearance of the patch material might, however, constitute an altered leaflet stress distribution in this area.",

keywords = "2-ply small intestinal submucosal extracellular matrix, CorMatrix, Mitral valve, Mitral valve patch repair, Mitral valve posterior leaflet, Mitral valve posterior leaflet reconstruction",

author = "Tj{\o}rnild, {Marcell J} and Skov, {S{\o}ren N} and Poulsen, {Karen B} and Mona Sharghbin and Benhassen, {Leila L} and {Carlson Hanse}, Lisa and Farhad Waziri and R{\o}pcke, {Diana M} and Nielsen, {Sten L} and Hasenkam, {J Michael}",

year = "2018",

doi = "10.1093/ejcts/ezy152",

language = "English",

volume = "54",

pages = "832--840",

journal = "European Journal of Cardio-Thoracic Surgery",

issn = "1010-7940",

publisher = "Oxford University Press",

number = "5",

}

Mitral valve posterior leaflet reconstruction using extracellular matrix: an acute porcine study. / Tjørnild, Marcell J ; Skov, Søren N; Poulsen, Karen B et al.
I: European Journal of Cardio-Thoracic Surgery, Bind 54, Nr. 5, 2018, s. 832-840.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Mitral valve posterior leaflet reconstruction using extracellular matrix

T2 - an acute porcine study

AU - Tjørnild, Marcell J

AU - Skov, Søren N

AU - Poulsen, Karen B

AU - Sharghbin, Mona

AU - Benhassen, Leila L

AU - Carlson Hanse, Lisa

AU - Waziri, Farhad

AU - Røpcke, Diana M

AU - Nielsen, Sten L

AU - Hasenkam, J Michael

PY - 2018

Y1 - 2018

N2 - OBJECTIVES: To investigate mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet.METHODS: Mitral valve posterior leaflet and subvalvular reconstruction was characterized in an acute 80-kg porcine model with 7 pigs acting as their own controls. The characterization was based on pressure catheter measurements of pressure differences to identify mitral regurgitation, stenosis and systolic anterior motion. Furthermore, echocardiography was used for the evaluation of leaflet mobility and geometry, whereas sonomicrometry was used to describe annular and subvalvular geometry.RESULTS: The reconstructed mitral valve was fully functional without any signs of regurgitation (peak left atrial pressure for baseline and reconstruction 12 ± 2 mmHg vs 11 ± 2 mmHg, P = 0.550), mitral valve stenosis (mean pressure difference across the mitral valve 4.8 ± 2.3 mmHg vs 4.1 ± 2.3 mmHg, P = 0.589) or systolic anterior motion. The echocardiographic characterization revealed septal-lateral downsizing, reduced tenting area, increased coaptation length (6.0 ± 0.6 mm vs 8.7 ± 2.3 mm, P = 0.002) and an atrial bend of the reconstructed posterior leaflet. A ballooning effect of the patch material was present at the posterior annular segment.CONCLUSIONS: Mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet as patch material was possible in an acute porcine model. The reconstructed mitral valve was fully functional without signs of mitral valve stenosis, valve regurgitation, stenosis or systolic anterior motion. The ballooning appearance of the patch material might, however, constitute an altered leaflet stress distribution in this area.

AB - OBJECTIVES: To investigate mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet.METHODS: Mitral valve posterior leaflet and subvalvular reconstruction was characterized in an acute 80-kg porcine model with 7 pigs acting as their own controls. The characterization was based on pressure catheter measurements of pressure differences to identify mitral regurgitation, stenosis and systolic anterior motion. Furthermore, echocardiography was used for the evaluation of leaflet mobility and geometry, whereas sonomicrometry was used to describe annular and subvalvular geometry.RESULTS: The reconstructed mitral valve was fully functional without any signs of regurgitation (peak left atrial pressure for baseline and reconstruction 12 ± 2 mmHg vs 11 ± 2 mmHg, P = 0.550), mitral valve stenosis (mean pressure difference across the mitral valve 4.8 ± 2.3 mmHg vs 4.1 ± 2.3 mmHg, P = 0.589) or systolic anterior motion. The echocardiographic characterization revealed septal-lateral downsizing, reduced tenting area, increased coaptation length (6.0 ± 0.6 mm vs 8.7 ± 2.3 mm, P = 0.002) and an atrial bend of the reconstructed posterior leaflet. A ballooning effect of the patch material was present at the posterior annular segment.CONCLUSIONS: Mitral valve posterior leaflet and subvalvular reconstruction using a 2-ply small intestinal submucosal extracellular matrix sheet as patch material was possible in an acute porcine model. The reconstructed mitral valve was fully functional without signs of mitral valve stenosis, valve regurgitation, stenosis or systolic anterior motion. The ballooning appearance of the patch material might, however, constitute an altered leaflet stress distribution in this area.

KW - 2-ply small intestinal submucosal extracellular matrix

KW - CorMatrix

KW - Mitral valve

KW - Mitral valve patch repair

KW - Mitral valve posterior leaflet

KW - Mitral valve posterior leaflet reconstruction

UR - http://www.scopus.com/inward/record.url?scp=85055071170&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezy152

DO - 10.1093/ejcts/ezy152

M3 - Journal article

C2 - 29897435

SN - 1010-7940

VL - 54

SP - 832

EP - 840

JO - European Journal of Cardio-Thoracic Surgery

JF - European Journal of Cardio-Thoracic Surgery

IS - 5

ER -

Mitral valve posterior leaflet reconstruction using extracellular matrix: an acute porcine study

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