Mitral Web - A New Concept for Mitral Valve Repair: Improved Engineering Design and In-Vitro Studies
Ersin Erek1, Muralidhar Padala3, Kerem Pekkan2, Jorge Jimenez3, Yusuf K. Yallnba1, Ece Saliholu1, Tayyar Sarlolu1, Ajit P. Yoganathan3
1 Department of Cardiovascular Surgery, Acibadem Hospital, Istanbul, Turkey, 2Department of Biomedical Engineering, Carnegie Mellon University, PA, USA, 3School of Biomedical Engineering, Georgia Institute of Technology, GA, USA
Background and aim of the study: A new mitral valve repair concept to treat mitral regurgitation (MR) due to valve prolapse was recently proposed. In this study, an improved design of this concept is presented, and the results of preliminary hemodynamic studies conducted in an in-vitro prolapse model are reported. Methods: The new repair approach is based on using a web/net attached to a standard annuloplasty ring spanning the annulus of the mitral valve. Experiments were conducted in a left ventricular simulator, using native porcine mitral valves. Severe MR was created by transecting the marginal chordae to induce P2 prolapse, and also by displacing the papillary muscles basally to induce bileaflet prolapse. Results: Implantation of the mitral web prevented
leaflet prolapse and restored leaflet coaptation with trace mitral insufficiency, in both posterior and bileaflet prolapse. In posterior leaflet prolapse, implantation of the mitral web reduced the regurgitation volume from 10.43 ± 3.76 ml to 2.13 ± 1.83 ml per beat (p <0.05). No visual damage was observed on the mitral valve leaflets after 4 h of continuous operation. Conclusion: Based on the study results, the mitral web may represent a feasible option to repair different types of mitral valve prolapse. The mitral web may also significantly simplify mitral valve repair for complex lesions
The Journal of Heart Valve Disease 2008;17:
Myxomatous mitral valve disease is currently the most common cause of mitral regurgitation in western countries (1). Several clinical studies have reported that mitral valve repair is preferable to valve replacement, as it offers certain advantages that include relief from long-term anticoagulation therapy, decreased operative mortality and improved long-term outcome. Although the vast majority of patients with posterior leaflet prolapse are amenable to repair with fairly standardized techniques (2,3), prolapse of the anterior cusp and bileaflet prolapse requires a more complex type of repair. The current repair techniques for mitral valve prolapse aim at restoring physiological mitral valve geometry by resecting the redundant leaflet tissue, chordal shortening, or by reconstructing the broken mitral

下一页