Entire Mitral Valve Reconstruction Using Porcine Extracellular Matrix: Adding a Ring Annuloplasty

Johannes H Jedrzejczyk; Stine Krog; Søren N Skov; Karen B Poulsen; Mona Sharghbin; Leila L Benhassen; Sten L Nielsen; J Michael Hasenkam; Marcell J Tjørnild

doi:10.1007/s13239-024-00727-0

Entire Mitral Valve Reconstruction Using Porcine Extracellular Matrix: Adding a Ring Annuloplasty

Johannes H Jedrzejczyk^*, Stine Krog, Søren N Skov, Karen B Poulsen, Mona Sharghbin, Leila L Benhassen, Sten L Nielsen, J Michael Hasenkam, Marcell J Tjørnild

^*Corresponding author for this work

Department of Clinical Medicine - Department of Cardiothoracic and Vascular Surgery

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Purpose: This study investigated the implications of inserting a flexible annuloplasty ring after reconstructing the entire mitral valve in a porcine model using a previously investigated tube graft design made of 2-ply small intestinal submucosa extracellular matrix (CorMatrix®). Methods: An acute model with eight 80-kg pigs, each acting as its own control, was used. The entire mitral valve was reconstructed with a 2-ply small intestinal submucosa extracellular matrix tube graft (CorMatrix®). Subsequently, a Simulus® flexible ring was inserted. The characterization was based on mitral annular geometry and valvular dynamics with sonomicrometry and echocardiography. Results: After adding the ring annuloplasty, the in-plane annular dynamics were more constant throughout the cardiac cycle compared to the reconstruction alone. However, the commissure–commissure distance was statistically significantly decreased [35.0 ± 3.4 mm vs. 27.4 ± 1.9 mm, P < 0.001, diff = − 7.6 mm, 95% CI, − 9.8 to (−5.4) mm] after ring insertion, changing the physiological annular D-shape into a circular shape which created folds at the coaptation zone resulting in a central regurgitant jet on color Doppler. Conclusion: We successfully reconstructed the entire mitral valve using 2-ply small intestinal submucosal extracellular matrix (CorMatrix®) combined with a flexible annuloplasty. The annuloplasty reduced the unphysiological systolic widening previously found with this reconstructive technique. However, the Simulus flex ring changed the physiological annular D-shape into a circular shape and hindered a correct unfolding of the leaflets. Thus, we do not recommend a flexible ring in conjunction with this reconstructive technique; further investigations are needed to discover a more suitable remodelling annuloplasty.

Original language	English
Journal	Cardiovascular Engineering and Technology
Volume	15
Issue	4
Pages (from-to)	451-462
Number of pages	12
ISSN	1869-408X
DOIs	https://doi.org/10.1007/s13239-024-00727-0
Publication status	Published - Aug 2024

Keywords

2-Ply small intestinal submucosa extracellular matrix
Annuloplasty ring
Mitral valve
Mitral valve reconstruction
Mitral valve repair
Mitral valve replacement

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10.1007/s13239-024-00727-0Licence: CC BY

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@article{6b66276db27e415eba5e029d76a4db33,

title = "Entire Mitral Valve Reconstruction Using Porcine Extracellular Matrix: Adding a Ring Annuloplasty",

abstract = "Purpose: This study investigated the implications of inserting a flexible annuloplasty ring after reconstructing the entire mitral valve in a porcine model using a previously investigated tube graft design made of 2-ply small intestinal submucosa extracellular matrix (CorMatrix{\textregistered}). Methods: An acute model with eight 80-kg pigs, each acting as its own control, was used. The entire mitral valve was reconstructed with a 2-ply small intestinal submucosa extracellular matrix tube graft (CorMatrix{\textregistered}). Subsequently, a Simulus{\textregistered} flexible ring was inserted. The characterization was based on mitral annular geometry and valvular dynamics with sonomicrometry and echocardiography. Results: After adding the ring annuloplasty, the in-plane annular dynamics were more constant throughout the cardiac cycle compared to the reconstruction alone. However, the commissure–commissure distance was statistically significantly decreased [35.0 ± 3.4 mm vs. 27.4 ± 1.9 mm, P < 0.001, diff = − 7.6 mm, 95% CI, − 9.8 to (−5.4) mm] after ring insertion, changing the physiological annular D-shape into a circular shape which created folds at the coaptation zone resulting in a central regurgitant jet on color Doppler. Conclusion: We successfully reconstructed the entire mitral valve using 2-ply small intestinal submucosal extracellular matrix (CorMatrix{\textregistered}) combined with a flexible annuloplasty. The annuloplasty reduced the unphysiological systolic widening previously found with this reconstructive technique. However, the Simulus flex ring changed the physiological annular D-shape into a circular shape and hindered a correct unfolding of the leaflets. Thus, we do not recommend a flexible ring in conjunction with this reconstructive technique; further investigations are needed to discover a more suitable remodelling annuloplasty.",

keywords = "2-Ply small intestinal submucosa extracellular matrix, Annuloplasty ring, Mitral valve, Mitral valve reconstruction, Mitral valve repair, Mitral valve replacement",

author = "Jedrzejczyk, {Johannes H} and Stine Krog and Skov, {S{\o}ren N} and Poulsen, {Karen B} and Mona Sharghbin and Benhassen, {Leila L} and Nielsen, {Sten L} and Hasenkam, {J Michael} and Tj{\o}rnild, {Marcell J}",

year = "2024",

month = aug,

doi = "10.1007/s13239-024-00727-0",

language = "English",

volume = "15",

pages = "451--462",

journal = "Cardiovascular Engineering and Technology",

issn = "1869-408X",

publisher = "Springer Publishing Company",

number = "4",

}

Entire Mitral Valve Reconstruction Using Porcine Extracellular Matrix: Adding a Ring Annuloplasty. / Jedrzejczyk, Johannes H; Krog, Stine; Skov, Søren N et al.
In: Cardiovascular Engineering and Technology, Vol. 15, No. 4, 08.2024, p. 451-462.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Entire Mitral Valve Reconstruction Using Porcine Extracellular Matrix

T2 - Adding a Ring Annuloplasty

AU - Jedrzejczyk, Johannes H

AU - Krog, Stine

AU - Skov, Søren N

AU - Poulsen, Karen B

AU - Sharghbin, Mona

AU - Benhassen, Leila L

AU - Nielsen, Sten L

AU - Hasenkam, J Michael

AU - Tjørnild, Marcell J

PY - 2024/8

Y1 - 2024/8

N2 - Purpose: This study investigated the implications of inserting a flexible annuloplasty ring after reconstructing the entire mitral valve in a porcine model using a previously investigated tube graft design made of 2-ply small intestinal submucosa extracellular matrix (CorMatrix®). Methods: An acute model with eight 80-kg pigs, each acting as its own control, was used. The entire mitral valve was reconstructed with a 2-ply small intestinal submucosa extracellular matrix tube graft (CorMatrix®). Subsequently, a Simulus® flexible ring was inserted. The characterization was based on mitral annular geometry and valvular dynamics with sonomicrometry and echocardiography. Results: After adding the ring annuloplasty, the in-plane annular dynamics were more constant throughout the cardiac cycle compared to the reconstruction alone. However, the commissure–commissure distance was statistically significantly decreased [35.0 ± 3.4 mm vs. 27.4 ± 1.9 mm, P < 0.001, diff = − 7.6 mm, 95% CI, − 9.8 to (−5.4) mm] after ring insertion, changing the physiological annular D-shape into a circular shape which created folds at the coaptation zone resulting in a central regurgitant jet on color Doppler. Conclusion: We successfully reconstructed the entire mitral valve using 2-ply small intestinal submucosal extracellular matrix (CorMatrix®) combined with a flexible annuloplasty. The annuloplasty reduced the unphysiological systolic widening previously found with this reconstructive technique. However, the Simulus flex ring changed the physiological annular D-shape into a circular shape and hindered a correct unfolding of the leaflets. Thus, we do not recommend a flexible ring in conjunction with this reconstructive technique; further investigations are needed to discover a more suitable remodelling annuloplasty.

AB - Purpose: This study investigated the implications of inserting a flexible annuloplasty ring after reconstructing the entire mitral valve in a porcine model using a previously investigated tube graft design made of 2-ply small intestinal submucosa extracellular matrix (CorMatrix®). Methods: An acute model with eight 80-kg pigs, each acting as its own control, was used. The entire mitral valve was reconstructed with a 2-ply small intestinal submucosa extracellular matrix tube graft (CorMatrix®). Subsequently, a Simulus® flexible ring was inserted. The characterization was based on mitral annular geometry and valvular dynamics with sonomicrometry and echocardiography. Results: After adding the ring annuloplasty, the in-plane annular dynamics were more constant throughout the cardiac cycle compared to the reconstruction alone. However, the commissure–commissure distance was statistically significantly decreased [35.0 ± 3.4 mm vs. 27.4 ± 1.9 mm, P < 0.001, diff = − 7.6 mm, 95% CI, − 9.8 to (−5.4) mm] after ring insertion, changing the physiological annular D-shape into a circular shape which created folds at the coaptation zone resulting in a central regurgitant jet on color Doppler. Conclusion: We successfully reconstructed the entire mitral valve using 2-ply small intestinal submucosal extracellular matrix (CorMatrix®) combined with a flexible annuloplasty. The annuloplasty reduced the unphysiological systolic widening previously found with this reconstructive technique. However, the Simulus flex ring changed the physiological annular D-shape into a circular shape and hindered a correct unfolding of the leaflets. Thus, we do not recommend a flexible ring in conjunction with this reconstructive technique; further investigations are needed to discover a more suitable remodelling annuloplasty.

KW - 2-Ply small intestinal submucosa extracellular matrix

KW - Annuloplasty ring

KW - Mitral valve

KW - Mitral valve reconstruction

KW - Mitral valve repair

KW - Mitral valve replacement

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U2 - 10.1007/s13239-024-00727-0

DO - 10.1007/s13239-024-00727-0

M3 - Journal article

C2 - 38504076

SN - 1869-408X

VL - 15

SP - 451

EP - 462

JO - Cardiovascular Engineering and Technology

JF - Cardiovascular Engineering and Technology

IS - 4

ER -

Entire Mitral Valve Reconstruction Using Porcine Extracellular Matrix: Adding a Ring Annuloplasty

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