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Takahashi Y, Morisaki A, Sakon Y, Nishiya K, Inno G, Kawase T, Nishimoto Y, Nagao M, Kishimoto N, Noda K, Shibata T. Three-dimensional computed tomography analysis of the mitral annulus for mitral annuloplasty in 100 cases of robotic mitral valve repair. Front Cardiovasc Med 2024; 11:1369801. [PMID: 39323752 PMCID: PMC11422080 DOI: 10.3389/fcvm.2024.1369801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 08/21/2024] [Indexed: 09/27/2024] Open
Abstract
Objectives This study aimed to evaluate the efficacy of preoperative computed tomography in assessing mitral annulus anatomy and the posterior annular plication rate in mitral valve repair with annuloplasty. Methods From July 2018 to August 2023, we performed robotic mitral valve repair with ring annuloplasty using a semi-rigid ring in 100 patients. Preoperative anatomical assessment of the mitral annulus was conducted by three-dimensional computed tomography. The ring size was selected based on the perioperative commissure-to-commissure length or the anterior leaflet area. Results The mean commissure-to-commissure length, posterior mitral annular length, and minimum distance between the left circumflex artery and mitral annulus values were 31, 109, and 3.8 mm, respectively. No postoperative left circumflex artery injury or ring detachment was recorded. The mean plication rate (length of the posterior side of the prosthetic ring/posterior annular length) was 0.68, and it did not differ among each prosthetic ring size. The posterior plication rate (duplicate ring size 19.4) was a factor influencing the postoperative transmitral mean pressure gradient of 5 mmHg or higher. Freedom from moderate or severe mitral regurgitation was not different between the two groups above and below the posterior plication rate × ring size of 19.4 (p = 0.73), with an event-free rate of 97% vs. 96% in 3 years, respectively. Conclusions Preoperative evaluation of the mitral annular anatomy is useful for safe mitral valve repair with ring annuloplasty. Determining ring size by focusing on the posterior annular plication rate may be a new method for ring size selection.
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Affiliation(s)
- Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Yoshito Sakon
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Kenta Nishiya
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Goki Inno
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Takumi Kawase
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Yukihiro Nishimoto
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Munehide Nagao
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Noriaki Kishimoto
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Kazuki Noda
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
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van Kampen A, Morningstar JE, Goudot G, Ingels N, Wenk JF, Nagata Y, Yaghoubian KM, Norris RA, Borger MA, Melnitchouk S, Levine RA, Jensen MO. Utilization of Engineering Advances for Detailed Biomechanical Characterization of the Mitral-Ventricular Relationship to Optimize Repair Strategies: A Comprehensive Review. Bioengineering (Basel) 2023; 10:601. [PMID: 37237671 PMCID: PMC10215167 DOI: 10.3390/bioengineering10050601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
The geometrical details and biomechanical relationships of the mitral valve-left ventricular apparatus are very complex and have posed as an area of research interest for decades. These characteristics play a major role in identifying and perfecting the optimal approaches to treat diseases of this system when the restoration of biomechanical and mechano-biological conditions becomes the main target. Over the years, engineering approaches have helped to revolutionize the field in this regard. Furthermore, advanced modelling modalities have contributed greatly to the development of novel devices and less invasive strategies. This article provides an overview and narrative of the evolution of mitral valve therapy with special focus on two diseases frequently encountered by cardiac surgeons and interventional cardiologists: ischemic and degenerative mitral regurgitation.
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Affiliation(s)
- Antonia van Kampen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Leipzig Heart Centre, University Clinic of Cardiac Surgery, 02189 Leipzig, Germany
| | - Jordan E. Morningstar
- Department of Regenerative Medicine and Cell Biology, University of South Carolina, Charleston, SC 29425, USA
| | - Guillaume Goudot
- Cardiac Ultrasound Laboratory, Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Neil Ingels
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA
| | - Jonathan F. Wenk
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY 40508, USA;
| | - Yasufumi Nagata
- Cardiac Ultrasound Laboratory, Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Koushiar M. Yaghoubian
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell Biology, University of South Carolina, Charleston, SC 29425, USA
| | - Michael A. Borger
- Leipzig Heart Centre, University Clinic of Cardiac Surgery, 02189 Leipzig, Germany
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Robert A. Levine
- Cardiac Ultrasound Laboratory, Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Morten O. Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR 72701, USA
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Levine RA, Nagata Y. Imaging Cardiac Valve Mechanics: A New Frontier. JACC Cardiovasc Imaging 2021; 14:794-796. [PMID: 33832662 DOI: 10.1016/j.jcmg.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Yasufumi Nagata
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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