Mitral Valve Posterior Leaflet Reconstruction Using Extracellular Matrix: In Vitro Evaluation

Marcell J Tjørnild; Søren W Sørensen; Lisa Carlson Hanse; Søren N Skov; Diana M Røpcke; Sten L Nielsen; J Michael Hasenkam

doi:10.1007/s13239-020-00472-0

Mitral Valve Posterior Leaflet Reconstruction Using Extracellular Matrix: In Vitro Evaluation

Marcell J Tjørnild, Søren W Sørensen, Lisa Carlson Hanse, Søren N Skov, Diana M Røpcke, Sten L Nielsen, J Michael Hasenkam

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

3 Citationer (Scopus)

Abstract

PURPOSE: To investigate the anatomical and functional effects of complete surgical reconstruction of the posterior mitral leaflet and associated chordae tendineae with a patch made of 2-ply small intestinal submucosal extracellular matrix in vitro.

METHODS: Seven explanted mitral valves with intact subvalvular apparatus from 80-kg pigs were evaluated in a left heart simulator and served as their own controls. After testing the native valve, the mitral posterior leaflet and associated chordae tendineae were excised and reconstructed by using the 2-ply small intestinal submucosa extracellular matrix patch. The characterization of the reconstruction was based on geometric data from digital images, papillary muscle force, annular tethering force and leaflet pressure force.

RESULTS: The reconstructed valves were fully functional without regurgitation, tearing or rupture during incrementally increased pressure from 0 to 120 mmHg. The leaflet areas were preserved after reconstruction, with a normal configuration of the coaptation line. However, the coaptation midpoint moved posteriorly after reconstruction (A2: 15.8 ± 1.4 vs. 18.9 ± 1.5 mm, p = 0.002, diff = 3.1 mm, 95% CI 1.3 to 4.8 mm). The anterior papillary muscle force increased significantly (3.9 vs. 4.6 N, p = 0.029, diff = 0.7 N, 95% CI 0.1 to 1.4 N at 120mmHg) after reconstruction. The posterior papillary muscle force, leaflet pressure force and annular pressure force did not change significantly.

CONCLUSIONS: In this in vitro model, mitral valve anatomy and function were comparable between the native mitral valve and our new surgical technique for complete reconstruction of the posterior mitral leaflet and associated chordae tendineae. These promising results warrant further in vivo evaluation.

Originalsprog	Engelsk
Tidsskrift	Cardiovascular Engineering and Technology
Vol/bind	11
Nummer	4
Sider (fra-til)	405-415
Antal sider	11
ISSN	1869-408X
DOI	https://doi.org/10.1007/s13239-020-00472-0
Status	Udgivet - aug. 2020

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10.1007/s13239-020-00472-0

Citationsformater

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title = "Mitral Valve Posterior Leaflet Reconstruction Using Extracellular Matrix: In Vitro Evaluation",

abstract = "PURPOSE: To investigate the anatomical and functional effects of complete surgical reconstruction of the posterior mitral leaflet and associated chordae tendineae with a patch made of 2-ply small intestinal submucosal extracellular matrix in vitro.METHODS: Seven explanted mitral valves with intact subvalvular apparatus from 80-kg pigs were evaluated in a left heart simulator and served as their own controls. After testing the native valve, the mitral posterior leaflet and associated chordae tendineae were excised and reconstructed by using the 2-ply small intestinal submucosa extracellular matrix patch. The characterization of the reconstruction was based on geometric data from digital images, papillary muscle force, annular tethering force and leaflet pressure force.RESULTS: The reconstructed valves were fully functional without regurgitation, tearing or rupture during incrementally increased pressure from 0 to 120 mmHg. The leaflet areas were preserved after reconstruction, with a normal configuration of the coaptation line. However, the coaptation midpoint moved posteriorly after reconstruction (A2: 15.8 ± 1.4 vs. 18.9 ± 1.5 mm, p = 0.002, diff = 3.1 mm, 95% CI 1.3 to 4.8 mm). The anterior papillary muscle force increased significantly (3.9 vs. 4.6 N, p = 0.029, diff = 0.7 N, 95% CI 0.1 to 1.4 N at 120mmHg) after reconstruction. The posterior papillary muscle force, leaflet pressure force and annular pressure force did not change significantly.CONCLUSIONS: In this in vitro model, mitral valve anatomy and function were comparable between the native mitral valve and our new surgical technique for complete reconstruction of the posterior mitral leaflet and associated chordae tendineae. These promising results warrant further in vivo evaluation.",

keywords = "2-ply small intestinal submucosa extracellular matrix, CorMatrix, Mitral valve reconstruction, Mitral valve repair, Papillary muscle force, Posterior leaflet reconstruction",

author = "Tj{\o}rnild, {Marcell J} and S{\o}rensen, {S{\o}ren W} and {Carlson Hanse}, Lisa and Skov, {S{\o}ren N} and R{\o}pcke, {Diana M} and Nielsen, {Sten L} and Hasenkam, {J Michael}",

year = "2020",

month = aug,

doi = "10.1007/s13239-020-00472-0",

language = "English",

volume = "11",

pages = "405--415",

journal = "Cardiovascular Engineering and Technology",

issn = "1869-408X",

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number = "4",

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Mitral Valve Posterior Leaflet Reconstruction Using Extracellular Matrix: In Vitro Evaluation. / Tjørnild, Marcell J; Sørensen, Søren W; Carlson Hanse, Lisa et al.
I: Cardiovascular Engineering and Technology, Bind 11, Nr. 4, 08.2020, s. 405-415.

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 - In Vitro Evaluation

AU - Tjørnild, Marcell J

AU - Sørensen, Søren W

AU - Carlson Hanse, Lisa

AU - Skov, Søren N

AU - Røpcke, Diana M

AU - Nielsen, Sten L

AU - Hasenkam, J Michael

PY - 2020/8

Y1 - 2020/8

N2 - PURPOSE: To investigate the anatomical and functional effects of complete surgical reconstruction of the posterior mitral leaflet and associated chordae tendineae with a patch made of 2-ply small intestinal submucosal extracellular matrix in vitro.METHODS: Seven explanted mitral valves with intact subvalvular apparatus from 80-kg pigs were evaluated in a left heart simulator and served as their own controls. After testing the native valve, the mitral posterior leaflet and associated chordae tendineae were excised and reconstructed by using the 2-ply small intestinal submucosa extracellular matrix patch. The characterization of the reconstruction was based on geometric data from digital images, papillary muscle force, annular tethering force and leaflet pressure force.RESULTS: The reconstructed valves were fully functional without regurgitation, tearing or rupture during incrementally increased pressure from 0 to 120 mmHg. The leaflet areas were preserved after reconstruction, with a normal configuration of the coaptation line. However, the coaptation midpoint moved posteriorly after reconstruction (A2: 15.8 ± 1.4 vs. 18.9 ± 1.5 mm, p = 0.002, diff = 3.1 mm, 95% CI 1.3 to 4.8 mm). The anterior papillary muscle force increased significantly (3.9 vs. 4.6 N, p = 0.029, diff = 0.7 N, 95% CI 0.1 to 1.4 N at 120mmHg) after reconstruction. The posterior papillary muscle force, leaflet pressure force and annular pressure force did not change significantly.CONCLUSIONS: In this in vitro model, mitral valve anatomy and function were comparable between the native mitral valve and our new surgical technique for complete reconstruction of the posterior mitral leaflet and associated chordae tendineae. These promising results warrant further in vivo evaluation.

AB - PURPOSE: To investigate the anatomical and functional effects of complete surgical reconstruction of the posterior mitral leaflet and associated chordae tendineae with a patch made of 2-ply small intestinal submucosal extracellular matrix in vitro.METHODS: Seven explanted mitral valves with intact subvalvular apparatus from 80-kg pigs were evaluated in a left heart simulator and served as their own controls. After testing the native valve, the mitral posterior leaflet and associated chordae tendineae were excised and reconstructed by using the 2-ply small intestinal submucosa extracellular matrix patch. The characterization of the reconstruction was based on geometric data from digital images, papillary muscle force, annular tethering force and leaflet pressure force.RESULTS: The reconstructed valves were fully functional without regurgitation, tearing or rupture during incrementally increased pressure from 0 to 120 mmHg. The leaflet areas were preserved after reconstruction, with a normal configuration of the coaptation line. However, the coaptation midpoint moved posteriorly after reconstruction (A2: 15.8 ± 1.4 vs. 18.9 ± 1.5 mm, p = 0.002, diff = 3.1 mm, 95% CI 1.3 to 4.8 mm). The anterior papillary muscle force increased significantly (3.9 vs. 4.6 N, p = 0.029, diff = 0.7 N, 95% CI 0.1 to 1.4 N at 120mmHg) after reconstruction. The posterior papillary muscle force, leaflet pressure force and annular pressure force did not change significantly.CONCLUSIONS: In this in vitro model, mitral valve anatomy and function were comparable between the native mitral valve and our new surgical technique for complete reconstruction of the posterior mitral leaflet and associated chordae tendineae. These promising results warrant further in vivo evaluation.

KW - 2-ply small intestinal submucosa extracellular matrix

KW - CorMatrix

KW - Mitral valve reconstruction

KW - Mitral valve repair

KW - Papillary muscle force

KW - Posterior leaflet reconstruction

U2 - 10.1007/s13239-020-00472-0

DO - 10.1007/s13239-020-00472-0

M3 - Journal article

C2 - 32592143

SN - 1869-408X

VL - 11

SP - 405

EP - 415

JO - Cardiovascular Engineering and Technology

JF - Cardiovascular Engineering and Technology

IS - 4

ER -

Mitral Valve Posterior Leaflet Reconstruction Using Extracellular Matrix: In Vitro Evaluation

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