Bibliographies thématiques / Neochordoplasty

Littérature scientifique sur le sujet « Neochordoplasty »

Auteur : Grafiati

Publié le 11 mars 2023

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Articles de revues sur le sujet "Neochordoplasty"

Choi, Ahnryul, David D. McPherson et Hyunggun Kim. « Neochordoplasty versus leaflet resection for ruptured mitral chordae treatment : Virtual mitral valve repair ». Computers in Biology and Medicine 90 (novembre 2017) : 50–58. http://dx.doi.org/10.1016/j.compbiomed.2017.09.006.

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Jahren, Silje Ekroll, Samuel Hurni, Paul Philipp Heinisch, Bernhard Winkler, Dominik Obrist, Thierry Carrel et Alberto Weber. « Transvalvular pressure gradients for different methods of mitral valve repair : only neochordoplasty achieves native valve gradients ». Interactive CardioVascular and Thoracic Surgery 26, n^o 2 (3 octobre 2017) : 248–55. http://dx.doi.org/10.1093/icvts/ivx323.

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Padala, Muralidhar, Scott N. Powell, Laura R. Croft, Vinod H. Thourani, Ajit P. Yoganathan et David H. Adams. « Mitral valve hemodynamics after repair of acute posterior leaflet prolapse : Quadrangular resection versus triangular resection versus neochordoplasty ». Journal of Thoracic and Cardiovascular Surgery 138, n^o 2 (août 2009) : 309–15. http://dx.doi.org/10.1016/j.jtcvs.2009.01.031.

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Choi, Ahnryul, Tom C. Nguyen, David D. McPherson et Hyunggun Kim. « Abstract 18319 : Virtual Mitral Valve Repair for Improved Pre-surgical Planning : Quantitative Evaluation of Neochordoplasty versus Leaflet Resection ». Circulation 132, suppl_3 (10 novembre 2015). http://dx.doi.org/10.1161/circ.132.suppl_3.18319.

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Background: Neochordoplasty and/or leaflet resection are reliable and reproducible mitral valve (MV) repair techniques for the treatment of chordal rupture with severe mitral regurgitation (MR). We developed a novel computational evaluation strategy to determine the biomechanical and physiologic characteristics of MV dynamics prior to and following potential MV repair techniques to optimize surgical planning for neochordoplasty or leaflet resection. Methods: Virtual MV models from patients with P2 chordal rupture and severe MR were created using 3D echocardiographic data (N=5). Virtual neochordoplasty was designed by adding six neochordae between the papillary muscles and the P2 scallop. Virtual resection was performed by removing a pre-defined quadrangular shaped leaflet portion in the P2 scallop and merging the excised leaflet edges. Computational simulations of MV function (pre- and post-repair) were performed using dynamic finite element methods. Coaptation lengths and leaflet stress distributions were evaluated. Results: The MVs with P2 chordal rupture demonstrated severe P2 prolapse, leaflet malcoaptation, and large stress concentrations. Both repair techniques markedly reduced posterior leaflet prolapse and restored sufficient leaflet coaptation. Virtual neochordoplasty showed larger coaptation lengths (A2-P2) compared to virtual resection. Excessive stress concentrations in the P2 scallop disappeared and peak stress values decreased by up to 85% following both repair techniques. Conclusion: We have quantitatively evaluated patient-specific MV function before and after potential MV repair using a novel virtual MV repair protocol. Both virtual neochordoplasty and leaflet resection techniques decreased posterior leaflet prolapse, lessened stress concentration, and restored leaflet coaptation. This virtual simulation strategy has the potential for improved pre-surgical planning to optimize post-repair MV function.

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Simões Costa, Sara, Mariana Brandão et Daniel Martins. « A potentially catastrophic complication of transapical mitral neochordoplasty ». Revista Española de Cardiología (English Edition), mai 2021. http://dx.doi.org/10.1016/j.rec.2021.03.004.

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Kaneyuki, Daisuke, Hiroyuki Nakajima, Toshihisa Asakura, Akihiro Yoshitake, Chiho Tokunaga, Masato Tochii, Jun Hayashi, Akitoshi Takazawa, Hiroaki Izumida et Atsushi Iguchi. « Recurrent mitral regurgitation after mitral valve repair for bileaflet lesions in the modern era ». Journal of Cardiothoracic Surgery 14, n^o 1 (27 novembre 2019). http://dx.doi.org/10.1186/s13019-019-1035-3.

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Abstract Background Good mid-term durability of mitral valve repair of bileaflet lesions has been reported; however, patients may develop failure during follow-up. This study assessed late outcomes and mechanisms of failure associated with mitral valve repair of bileaflet lesions. Methods Fifty-six patients (mean age 67 ± 12 years) underwent mitral valve repair of bileaflet lesions due to degenerative disease in 2011–2018. Mitral annuloplasty was added to all procedures except for 1 patient with annular calcification. Mitral valve lesions were identified by surgical inspection. Mean clinical and echocardiography follow-up occurred at 2.7 ± 2.1 and 2.5 ± 1.9 years, respectively. Results Additional mitral valve repair techniques involved triangular resection (n = 15 patients), quadrangular resection with sliding plasty (n = 12), neochordoplasty (n = 52), and commissural plication (n = 26). Prolapse of ≥2 anterior and posterior leaflet scallops occurred in 22 (39%) and 30 (54%) patients, respectively. During follow-up, 10 (17.8%) patients developed moderate or severe mitral regurgitation. Whereas prolapse or tethering was observed early after neochordoplasty or quadrangular resection, recurrent regurgitation occurred late after commissural repair. Five-year freedom from recurrent moderate or severe mitral regurgitation rates was 71.1 ± 11.0%. Conclusions Seventeen percent of patients developed recurrent mitral regurgitation during follow-up. Repair failure in the early phase occurred owing to aggressive resection of the posterior mitral leaflet or maladjustment of the artificial neochordae. Recurrent mitral regurgitation might occur in the late phase even after acceptable commissural repair. A sequential approach may be useful to improve the quality of mitral valve repair in bileaflet lesions.

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Paulsen, Michael J., Jung Hwa Bae, Annabel M. Imbrie-Moore, Hanjay Wang, Justin M. Farry, Michael A. Lin, Camille E. Hironaka et al. « Abstract 17080 : A 3D Printed Ex Vivo Left Heart Simulator Quantifies and Validates Posterior Ventricular Anchoring Neochordoplasty ». Circulation 138, Suppl_1 (6 novembre 2018). http://dx.doi.org/10.1161/circ.138.suppl_1.17080.

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Introduction: The posterior ventricular anchoring neochordal (PVAN) repair is a nonresectional, single-suture technique for correcting posterior leaflet prolapse. While this technique has demonstrated clinical efficacy, a possible limitation is the stability of the suture anchored into myocardium as opposed to the fibrous portion of a papillary muscle. Hypothesis: We hypothesize that the PVAN suture serves only to position the leaflet for coaptation, after which systolic forces will be distributed throughout the valve, resulting in low peak forces on the suture. Methods: A left heart simulator was constructed using 3D printing, tuned to generate physiological pressure and flow waveforms, then validated. Porcine mitral valves (n=9) were dissected and mounted within the simulator. Chordal forces were measured using Fiber Bragg Grating (FBG) sensors, sewn in place using PTFE suture. FBG sensors are strain gauges made of 125 μ m optical fibers that use reflected peak wavelength changes to measure strain. Hemodynamic and echocardiographic data were also collected. Isolated severe mitral regurgitation (MR) was induced by cutting P2 primary chordae. The valve was repaired using the PVAN technique, anchoring the suture to a customized force-sensing post positioned to mimic in vivo placement. Results: Forces on 1° and 2° chordae of both anterior and posterior leaflets were significantly elevated in the prolapse condition ( P < 0.05). PVAN resulted in elimination of MR in all valves, as well as normalization of chordae forces to baseline levels for posterior primary ( P < 0.01 ) , posterior secondary ( P < 0.01 ) , and anterior primary chordae ( P < 0.05 ) , with reduction in anterior secondary chordal forces approaching significance ( P = 0.055 ) . Peak forces on the PVAN stitch were minimal, even compared to the forces experienced by primary chordae of normal, healthy valves ( P < 0.05). Conclusions: The PVAN technique eliminates MR by effectively positioning the posterior leaflet for optimal coaptation, distributing the forces amongst the subvalvular apparatus. Given the extremely low forces involved, the strength of the ventricular anchoring suture and myocardial anchoring point should not be a limiting factor.

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« A robotic-assisted approach to sliding plasty, neochordoplasty, and annuloplasty in a technically complex mitral valve repair ». Multimedia Manual of Cardio-Thoracic Surgery, 26 janvier 2023. http://dx.doi.org/10.1510/mmcts.2022.057.

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In experienced hands, complex mitral valve repair can be safely and effectively performed in a totally endoscopic, robotic-assisted manner. We present a technically complex case of a 76-year-old man with severe, symptomatic mitral regurgitation due to Barlow’s disease, moderate-to-severe tricuspid regurgitation, and atrial fibrillation.

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Xu, Dongyang, Kirthana Sreerangathama Suresh, Hirschel Nambiar, Qi He et Muralidhar Padala. « Abstract 11415 : Extent of Leaflet Coaptation Governs the Biomechanics of Mitral Valve Neochordae Used for Posterior Leaflet Prolapse ». Circulation 144, Suppl_1 (16 novembre 2021). http://dx.doi.org/10.1161/circ.144.suppl_1.11415.

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Introduction: Reducing peak forces and stresses on the neochordae used to repair mitral valve prolapse, can inhibit their late failure, and increase repair durability. Restoring a larger shelf of leaflet coaptation at the time of repair, could reduce neochordae stresses and aid durability. Hypothesis: In this study, we hypothesized that using a slightly smaller annuloplasty ring can yield a higher systolic coaptation length, which in turn could reduce the neochordal forces/stresses. Methods: Pig MV (n=7) were excised and studied in a pulsatile left heart simulator ( Fig. A ), with P2 prolapse induced by transecting the marginal chordae ( Fig B1,2 ). Repair was performed with force transducer instrumented Goretex PTFE suture loops (6-0) ( Figure C1,2 ), and annuloplasty with a custom adjustable ring that could be reduced from 36mm to 30mm in 2mm increments ( Fig D1,2 ). Regurgitant fraction, leaflet coaptation, and temporal neochordae force traces were measured. Results: P2 prolapse increased MR compared to baseline (10.5 ± 7.7% vs 0%, p=0.0001), which was reduced by neochordoplasty and annuloplasty ( Fig. E ). Leaflet coaptation length increased from 0mm to 11.3 ± 3.8mm with neochordae alone, and further increased with annuloplasty to 12.7 ± 3.6mm with 34mm, 14.8 ± 4.4mm with 32mm and 15.7 ± 3.9mm with 30mm ( Fig. F ). With increasing coaptation, the peak neochordae forces reduced ( Fig G, H ), demonstrating a negative correlation between parameters ( Fig I ). Conclusions: Neochordal forces can be reduced by increasing the coaptation length with slight downsizing of the mitral annulus. An operative strategy achieving larger coaptation can yield a biomechanically optimal repair configuration, potentially improving durability.

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Kaneyuki, Daisuke, Hiroyuki Nakajima, Toshihisa Asakura, Akihiro Yoshitake, Chiho Tokunaga, Masato Tochii, Jun Hayashi, Akitoshi Takazawa, Hiroaki Izumida et Atsushi Iguchi. « Midterm results of mitral valve repair for atrial functional mitral regurgitation : a retrospective study ». Journal of Cardiothoracic Surgery 15, n^o 1 (12 octobre 2020). http://dx.doi.org/10.1186/s13019-020-01362-1.

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Abstract Background Annular dilation by left atrial remodeling is considered the main cause of atrial function mitral regurgitation. Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure are limited. Therefore, we aimed to assess midterm outcomes of mitral valve repair in patients with atrial functional mitral regurgitation. Methods We retrospectively studied 40 patients (mean age: 69 ± 9 years) who had atrial fibrillation that persisted for > 1 year, preserved left ventricular ejection fraction of > 40%, and mitral valve repair for atrial functional mitral regurgitation. The mean clinical follow-up duration was 42 ± 24 months. Results Mitral ring annuloplasty was performed for all patients. Additional repair including anterior mitral leaflet neochordoplasty was performed for 22 patients. Concomitant procedures included maze procedure in 20 patients and tricuspid ring annuloplasty in 31 patients. Follow-up echocardiography showed significant decreases in left atrial dimensions and left ventricular end-diastolic dimensions. Recurrent mitral regurgitation due to ring detachment or leaflet tethering was observed in five patients and was seen more frequently among those with preoperative left ventricular dilatation. Three patients without tricuspid ring annuloplasty or sinus rhythm recovery by maze procedure developed significant tricuspid regurgitation. Five patients who underwent the maze procedure showed sinus rhythm recovery. Rates of freedom from re-admission for heart failure at 1 and 5 years after surgery were 95 and 86%, respectively. Conclusions Mitral valve repair is not sufficient to prevent recurrent atrial functional mitral regurgitation in patients with preoperative left ventricular dilatation. Tricuspid ring annuloplasty may be required for long-term prevention of significant tricuspid regurgitation.

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