ArticleEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2020
Mitral chordae tendineae force profile characterization using a posterior ventricular anchoring neochordal repair model for mitral regurgitation in a three-dimensional-printed ex vivo left heart simulator.
Article in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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28 citing papers in PubMed, 36 citations in OpenAlex.
- Design and evaluation of valve interventions using ex vivo biomechanical modeling: the Stanford experience.General thoracic and cardiovascular surgery · 2025Review
- A Novel Transcatheter Posterior Ventricular Anchoring Neochordoplasty Mitral Valve Repair Device.Cardiovascular engineering and technology · 2025Article
- An axis-specific mitral annuloplasty ring eliminates mitral regurgitation allowing mitral annular motion in an ovine model.Communications medicine · 2025Article
- Neochordal Goldilocks: Analyzing the biomechanics of neochord length on papillary muscle forces suggests higher tolerance to shorter neochordae.The Journal of thoracic and cardiovascular surgery · 2024Article
- Biomechanical engineering analysis of neochordae length's impact on chordal forces in mitral repair.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2024Article
- Neochords: How long, how many, too many?JTCVS techniques · 2023Article
- Repairable ex vivo model of functional and degenerative mitral regurgitation.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2023Article
- Chordal force profile after neochordal repair of anterior mitral valve prolapse: An ex vivo study.JTCVS open · 2023Article
- Utilization of Engineering Advances for Detailed Biomechanical Characterization of the Mitral-Ventricular Relationship to Optimize Repair Strategies: A Comprehensive Review.Bioengineering (Basel, Switzerland) · 2023Review
- A Novel Rheumatic Mitral Valve Disease Model with Ex Vivo Hemodynamic and Biomechanical Validation.Cardiovascular engineering and technology · 2023Article
- Artificial papillary muscle device for off-pump transapical mitral valve repair.The Journal of thoracic and cardiovascular surgery · 2022Article
- Quantitative biomechanical optimization of neochordal implantation location on mitral leaflets during valve repair.JTCVS techniques · 2022Article
- Biomechanical engineering analysis of an acute papillary muscle rupture disease model using an innovative 3D-printed left heart simulator.Interactive cardiovascular and thoracic surgery · 2022Article
- Ex vivo biomechanical analysis of flexible versus rigid annuloplasty rings in mitral valves using a novel annular dilation system.BMC cardiovascular disorders · 2022Article
- Commentary: Valvular mimicry in simulation-espice, adspice, prospice.The Journal of thoracic and cardiovascular surgery · 2022Article
- Novel bicuspid aortic valve model with aortic regurgitation for hemodynamic status analysis using an ex vivo simulator.The Journal of thoracic and cardiovascular surgery · 2022Article
- Mitral Valve Prolapse Induces Regionalized Myocardial Fibrosis.Journal of the American Heart Association · 2021Article
- Commentary: Biomechanical differences after mitral valve repair: Is it time to use the science?JTCVS techniques · 2021Article
- Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional-printed left heart simulator.JTCVS techniques · 2021Article
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
Abstract
objectivesPosterior ventricular anchoring neochordal (PVAN) repair is a non-resectional technique for correcting mitral regurgitation (MR) due to posterior leaflet prolapse, utilizing a single suture anchored in the myocardium behind the leaflet. This technique has demonstrated clinical efficacy, although a theoretical limitation is stability of the anchoring suture. We hypothesize that the PVAN suture positions the leaflet for coaptation, after which forces are distributed evenly with low repair suture forces.
methodsPorcine mitral valves were mounted in a 3-dimensional-printed heart simulator and chordal forces, haemodynamics and echocardiography were collected at baseline, after inducing MR by severing chordae, and after PVAN repair. Repair suture forces were measured with a force-sensing post positioned to mimic in vivo suture placement. Forces required to pull the myocardial suture free were also determined.
resultsRelative primary and secondary chordae forces on both leaflets were elevated during prolapse (P < 0.05). PVAN repair eliminated MR in all valves and normalized chordae forces to baseline levels on anterior primary (0.37 ± 0.23 to 0.22 ± 0.09 N, P < 0.05), posterior primary (0.62 ± 0.37 to 0.14 ± 0.05 N, P = 0.001), anterior secondary (1.48 ± 0.52 to 0.85 ± 0.43 N, P < 0.001) and posterior secondary chordae (1.42 ± 0.69 to 0.59 ± 0.17 N, P = 0.005). Repair suture forces were minimal, even compared to normal primary chordae forces (0.08 ± 0.04 vs 0.19 ± 0.08 N, P = 0.002), and were 90 times smaller than maximum forces tolerated by the myocardium (0.08 ± 0.04 vs 6.9 ± 1.3 N, P < 0.001). DISCUSSION: PVAN repair eliminates MR by positioning the posterior leaflet for coaptation, distributing forces throughout the valve. Given extremely low measured forces, the strength of the repair suture and the myocardium is not a limitation.
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