Biomechanical engineering analysis of commonly utilized mitral neochordae

Marín-Cuartas, Mateo; Imbrie-Moore, Annabel M.; Zhu, Yuanjia; Park, Matthew H.; Wilkerson, Robert; Leipzig, Matthew; Borger, Michael A.; Woo, Y. Joseph

doi:10.1016/j.xjon.2021.07.040

Cited by 13 publications

(18 citation statements)

References 18 publications

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“…In terms of the impact of neochordae number on chordal forces, a previous study evaluated the impact of different types of neochord repair techniques and the effect of neochordae number on rupture force. 48 A greater number of neochordae was reported to significantly increase the neochord rupture force, which is the expected result, as the same amount of total force distributed among more chordae implies lower individual chordal forces. However, this aforementioned study evaluated the impact of neochordae number using a benchtop tensile force analysis machine, completely excluding all other intracardiac factors, 48 and no information on native chordal forces was available.…”

Section: Discussionmentioning

confidence: 64%

Large Animal Translational Validation of 3 Mitral Valve Repair Operations for Mitral Regurgitation Using a Mitral Valve Prolapse Model: A Comprehensive In Vivo Biomechanical Engineering Analysis

Zhu,

Yajima,

Park

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: Various mitral repair techniques have been described. Though these repair techniques can be highly effective when performed correctly in suitable patients, limited quantitative biomechanical data are available. Validation and thorough biomechanical evaluation of these repair techniques from translational large animal in vivo studies in a standardized, translatable fashion are lacking. We sought to evaluate and validate biomechanical differences among different mitral repair techniques and further optimize repair operations using a large animal mitral valve prolapse model. METHODS: Male Dorset sheep (n=20) had P2 chordae severed to create the mitral valve prolapse model. Fiber Bragg grating force sensors were implanted to measure chordal forces. Ten sheep underwent 3 randomized, paired mitral valve repair operations: neochord repair, nonresectional leaflet remodeling, and triangular resection. The other 10 sheep underwent neochord repair with 2, 4, and 6 neochordae. Data were collected at baseline, mitral valve prolapse, and after each repair. RESULTS: All mitral repair techniques successfully eliminated regurgitation. Compared with mitral valve prolapse (0.54±0.18 N), repair using neochord (0.37±0.20 N; P =0.02) and remodeling techniques (0.30±0.15 N; P =0.001) reduced secondary chordae peak force. Neochord repair further decreased primary chordae peak force (0.21±0.14 N) to baseline levels (0.20±0.17 N; P =0.83), and was associated with lower primary chordae peak force compared with the remodeling (0.34±0.18 N; P =0.02) and triangular resectional techniques (0.36±0.27 N; P =0.03). Specifically, repair using 2 neochordae resulted in higher peak primary chordal forces (0.28±0.21 N) compared with those using 4 (0.22±0.16 N; P =0.02) or 6 neochordae (0.19±0.16 N; P =0.002). No difference in peak primary chordal forces was observed between 4 and 6 neochordae ( P =0.05). Peak forces on the neochordae were the lowest using 6 neochordae (0.09±0.11 N) compared with those of 4 neochordae (0.15±0.14 N; P =0.01) and 2 neochordae (0.29±0.18 N; P =0.001). CONCLUSIONS: Significant biomechanical differences were observed underlying different mitral repair techniques in a translational large animal model. Neochord repair was associated with the lowest primary chordae peak force compared to the remodeling and triangular resectional techniques. Additionally, neochord repair using at least 4 neochordae was associated with lower chordal forces on the primary chordae and the neochordae. This study provided key insights about mitral valve repair optimization and may further improve repair durability.

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Section: Discussionmentioning

confidence: 64%

Large Animal Translational Validation of 3 Mitral Valve Repair Operations for Mitral Regurgitation Using a Mitral Valve Prolapse Model: A Comprehensive In Vivo Biomechanical Engineering Analysis

Zhu,

Yajima,

Park

et al. 2024

Circ: Cardiovascular Interventions

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“…Although previous studies have examined variation of technique and anchoring location on the subvalvular apparatus, 8 , 9 this study seeks to understand the biomechanical effects of suture placement on the leaflet. During neochordal implantation, distance from the leaflet leading edge is manipulated to reestablish the coaptation plane.…”

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confidence: 99%

Quantitative biomechanical optimization of neochordal implantation location on mitral leaflets during valve repair

et al. 2022

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“…Marin-Cuartas and colleagues 2 measured the rupture force of expanded polytetrafluoroethylene neochords in vitro. They constructed 2 plastic hoops through which sutures were passed either as a series of interrupted sutures, a running suture line, or via the loop technique to simulate neochord mitral repair techniques.…”

mentioning

confidence: 99%

Commentary: Neochord integrity: More than just initial breaking strength

DeCampli

2021

JTCVS Open

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Biomechanical engineering analysis of commonly utilized mitral neochordae

Cited by 13 publications

References 18 publications

Large Animal Translational Validation of 3 Mitral Valve Repair Operations for Mitral Regurgitation Using a Mitral Valve Prolapse Model: A Comprehensive In Vivo Biomechanical Engineering Analysis

Large Animal Translational Validation of 3 Mitral Valve Repair Operations for Mitral Regurgitation Using a Mitral Valve Prolapse Model: A Comprehensive In Vivo Biomechanical Engineering Analysis

Quantitative biomechanical optimization of neochordal implantation location on mitral leaflets during valve repair

Commentary: Neochord integrity: More than just initial breaking strength

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