An analytical, mathematical annuloplasty ring curvature model for planning of valve-in-ring transcatheter mitral valve replacementCentral MessagePerspective
Objectives: An increasing number of high-risk patients with previous mitral valve annuloplasty require transcatheter mitral valve replacement due to recurrent regurgitation. Annulus dilation with a transcatheter balloon is often performed before valve-in-ring transcatheter mitral valve replacement,...
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| Language: | English |
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Elsevier
2023-08-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723001219 |
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| author | Matthew H. Park, MS Mateo Marin-Cuartas, MD Mark Sellke, PhD Pearly K. Pandya, MS Yuanjia Zhu, MD, PhD Robert J. Wilkerson, BS David M. Holzhey, MD, PhD Michael A. Borger, MD, PhD Y. Joseph Woo, MD |
| author_facet | Matthew H. Park, MS Mateo Marin-Cuartas, MD Mark Sellke, PhD Pearly K. Pandya, MS Yuanjia Zhu, MD, PhD Robert J. Wilkerson, BS David M. Holzhey, MD, PhD Michael A. Borger, MD, PhD Y. Joseph Woo, MD |
| author_sort | Matthew H. Park, MS |
| collection | DOAJ |
| description | Objectives: An increasing number of high-risk patients with previous mitral valve annuloplasty require transcatheter mitral valve replacement due to recurrent regurgitation. Annulus dilation with a transcatheter balloon is often performed before valve-in-ring transcatheter mitral valve replacement, which is believed to reduce misalignment and paravalvular leakage, yet little evidence exists to support this practice. Our objective was to generate intuitive annuloplasty ring analyses for improved valve-in-ring transcatheter mitral valve replacement planning. Methods: We generated a mathematical model that calculates image-tracked differential ring curvature to build quantifications for improved planning for valve-in-ring procedures. Carpentier-Edwards Physio M24 and M30 (n = 2 each), Physio II M24 and M26 (n = 3 each), LivaNova AnnuloFlex M26 (n = 2), and Edwards Geoform M28 (n = 2) rings were tested with a 30-mm Toray Inoue balloon inflated to maximum rated pressures. Results: Curvature variance reduces with larger ring sizes, indicating that larger rings are initially more circular than smaller ones. Evaluated semi-rigid and rigid rings showed little to no difference between pre- and post-dilation states. Annuloflex rings (flexible band) showed a postdilation variance reduction of 32.83% (P < .001) followed by an increase after 10 minutes of relaxation that was still reduced by 19.62% relative to the initial state (P < .001). Conclusions: We discovered that balloon dilation does not significantly deform evaluated semi-rigid or rigid rings at maximum rated balloon pressures. This may mean that dilation for these conditions before valve-in-ring transcatheter mitral valve replacement is unnecessary. Our mathematical approach creates a foundation for extended classification of this practice, providing meaningful quantification of ring geometry. |
| format | Article |
| id | doaj-art-db3e66d6c9e64cdf9f31b7c29db3be90 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-db3e66d6c9e64cdf9f31b7c29db3be902025-08-20T03:38:26ZengElsevierJTCVS Techniques2666-25072023-08-0120455410.1016/j.xjtc.2023.03.022An analytical, mathematical annuloplasty ring curvature model for planning of valve-in-ring transcatheter mitral valve replacementCentral MessagePerspectiveMatthew H. Park, MS0Mateo Marin-Cuartas, MD1Mark Sellke, PhD2Pearly K. Pandya, MS3Yuanjia Zhu, MD, PhD4Robert J. Wilkerson, BS5David M. Holzhey, MD, PhD6Michael A. Borger, MD, PhD7Y. Joseph Woo, MD8Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Mechanical Engineering, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif; University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, GermanyDepartment of Mathematics, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Mechanical Engineering, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, CalifUniversity Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, GermanyUniversity Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, GermanyDepartment of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif; Address for reprints: Y. Joseph Woo, MD, Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Dr, Stanford, CA 94305-5407.Objectives: An increasing number of high-risk patients with previous mitral valve annuloplasty require transcatheter mitral valve replacement due to recurrent regurgitation. Annulus dilation with a transcatheter balloon is often performed before valve-in-ring transcatheter mitral valve replacement, which is believed to reduce misalignment and paravalvular leakage, yet little evidence exists to support this practice. Our objective was to generate intuitive annuloplasty ring analyses for improved valve-in-ring transcatheter mitral valve replacement planning. Methods: We generated a mathematical model that calculates image-tracked differential ring curvature to build quantifications for improved planning for valve-in-ring procedures. Carpentier-Edwards Physio M24 and M30 (n = 2 each), Physio II M24 and M26 (n = 3 each), LivaNova AnnuloFlex M26 (n = 2), and Edwards Geoform M28 (n = 2) rings were tested with a 30-mm Toray Inoue balloon inflated to maximum rated pressures. Results: Curvature variance reduces with larger ring sizes, indicating that larger rings are initially more circular than smaller ones. Evaluated semi-rigid and rigid rings showed little to no difference between pre- and post-dilation states. Annuloflex rings (flexible band) showed a postdilation variance reduction of 32.83% (P < .001) followed by an increase after 10 minutes of relaxation that was still reduced by 19.62% relative to the initial state (P < .001). Conclusions: We discovered that balloon dilation does not significantly deform evaluated semi-rigid or rigid rings at maximum rated balloon pressures. This may mean that dilation for these conditions before valve-in-ring transcatheter mitral valve replacement is unnecessary. Our mathematical approach creates a foundation for extended classification of this practice, providing meaningful quantification of ring geometry.http://www.sciencedirect.com/science/article/pii/S2666250723001219mitral valveannuloplastyvalve-in-ringtranscatheter mitral valve replacementex vivo analysis |
| spellingShingle | Matthew H. Park, MS Mateo Marin-Cuartas, MD Mark Sellke, PhD Pearly K. Pandya, MS Yuanjia Zhu, MD, PhD Robert J. Wilkerson, BS David M. Holzhey, MD, PhD Michael A. Borger, MD, PhD Y. Joseph Woo, MD An analytical, mathematical annuloplasty ring curvature model for planning of valve-in-ring transcatheter mitral valve replacementCentral MessagePerspective JTCVS Techniques mitral valve annuloplasty valve-in-ring transcatheter mitral valve replacement ex vivo analysis |
| title | An analytical, mathematical annuloplasty ring curvature model for planning of valve-in-ring transcatheter mitral valve replacementCentral MessagePerspective |
| title_full | An analytical, mathematical annuloplasty ring curvature model for planning of valve-in-ring transcatheter mitral valve replacementCentral MessagePerspective |
| title_fullStr | An analytical, mathematical annuloplasty ring curvature model for planning of valve-in-ring transcatheter mitral valve replacementCentral MessagePerspective |
| title_full_unstemmed | An analytical, mathematical annuloplasty ring curvature model for planning of valve-in-ring transcatheter mitral valve replacementCentral MessagePerspective |
| title_short | An analytical, mathematical annuloplasty ring curvature model for planning of valve-in-ring transcatheter mitral valve replacementCentral MessagePerspective |
| title_sort | analytical mathematical annuloplasty ring curvature model for planning of valve in ring transcatheter mitral valve replacementcentral messageperspective |
| topic | mitral valve annuloplasty valve-in-ring transcatheter mitral valve replacement ex vivo analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723001219 |
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