title: Pre-clinical Experience with a Multi-Chordal Patch for Mitral Valve Repair.
abstract: Surgical repair of flail mitral valve leaflets with neochordoplasty has good outcomes, but implementing it in anterior and bi-leaflet leaflet repair is challenging. Placing and sizing individual neochordae is time consuming and error prone, with persistent localized flail if performed incorrectly. In this study, we report our pre-clinical experience with a novel multi-chordal patch for mitral valve repair. The device was designed based on human cadaver hearts, and laser cut from expanded polytetrafluoroethylene. The prototypes were tested in: (stage 1) ex vivo hearts with leaflet flail (N = 6), (stage 2) acute swine induced with flail (N = 6), and (stage 3) two chronic swine survived to 23 and 120 days (N = 2). A2 and P2 prolapse were successfully repaired with coaptation length restored to 8.1 ± 2.2mm after posterior repair and to 10.2 ± 1.3mm after anterior repair in ex vivo hearts. In vivo, trace regurgitation was seen after repair with excellent patch durability, healing, and endothelialization at euthanasia. A new device for easier mitral repair is reported, with good early pre-clinical outcomes.
authors.affiliation: Division of Cardiothoracic Surgery, Saint Francis Hospital and Medical Center, Hartford, CT, USA.
authors.forename: Surendra K
authors.initials: SK
authors.lastname: Chawla
authors.affiliation: Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Division of Cardiothoracic Surgery, Emory University, 380-B, Northyards Blvd, Atlanta, GA, 30313, USA.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Shi
authors.affiliation: Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Division of Cardiothoracic Surgery, Emory University, 380-B, Northyards Blvd, Atlanta, GA, 30313, USA.
authors.forename: Bryant V
authors.initials: BV
authors.lastname: McIver
authors.affiliation: Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Division of Cardiothoracic Surgery, Emory University, 380-B, Northyards Blvd, Atlanta, GA, 30313, USA.
authors.forename: Jakob
authors.initials: J
authors.lastname: Vinten-Johansen
authors.affiliation: Division of Cardiothoracic Surgery, Albert Einstein School of Medicine, New York, NY, USA.
authors.forename: Robert W M
authors.initials: RW
authors.lastname: Frater
authors.affiliation: Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Division of Cardiothoracic Surgery, Emory University, 380-B, Northyards Blvd, Atlanta, GA, 30313, USA. spadala@emory.edu.
authors.forename: Muralidhar
authors.initials: M
authors.lastname: Padala
mesh_terms: D000818:Animals; D002102:Cadaver; D002815:Chordae Tendineae / Q000637:transplantation*; D004195:Disease Models, Animal; D018618:Echocardiography, Doppler, Color; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D020127:Recovery of Function; D034421:Sus scrofa; D013997:Time Factors
chemical_list: D011138:Polytetrafluoroethylene
keywords: Chordal replacement; Device; Mitral regurgitation; Mitral valve prolapse; Mitral valve repair; Neochordoplasty; Robotic mitral repair; Valve surgery