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In Silico Analysis Provides Insights for Patient-Specific Annuloplasty in Barlow´s Disease

Open AccessPublished:January 23, 2023DOI:https://doi.org/10.1016/j.xjon.2023.01.007
In Silico Analysis Provides Insights for Patient-Specific Annuloplasty in Barlow´s Disease
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      Objectives

      The objective of the present study was to predict the required mitral annular area reduction in Barlow patients to obtain a predefined leaflet area index by a novel in silico modeling method.

      Methods

      Three-dimensional echocardiography was used to create patient-specific mitral valve models of eight patients diagnosed with Barlow’s disease and bileaflet prolapse pre-operatively. Six patients were also studied post-operatively in a finite element framework, to quantify the optimal coaptation area index. For the patient-specific finite element analyses, realistic papillary muscle and annular motion are incorporated, also for the in silico annuloplasty analyses. The annuloplasty ring size is reduced moderately until the optimal coaptation area index is achieved for each patient.

      Results

      The mean mitral annular area at end-diastole was reduced by 58 ± 7% post-operatively (p < 0.001), resulting in a post-operative coaptation area index of 20 ± 5%. To achieve the same coaptation area index with moderate annular reductions and no leaflet resection the annular reduction was 31 ± 6% (p < 0.001) .

      Conclusion

      In silico analysis in selected Barlow’s patients demonstrates that annuloplasty with only moderate annular reduction may be sufficient to achieve optimal coaptation as compared to conventional surgical procedures.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Keywords

      Glossary of Abbreviations:

      BD (Barlow’s Disease), CAI (coaptation area index), ED (end diastole), FE (finite element), LS (late systole), MAA (mitral annular area), MAD (mitral annular disjunction), MR (mitral regurgitation), MRS (mitral regurgitation start), MVO (mitral valve opening), SAM (systolic anterior motion), SLA (segmented leaflet area)

      Article info

      Publication history

      Accepted: January 18, 2023
      Received: January 17, 2023

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Disclosures: None

      Funding Statement: This document is the result of the research project funded by the Trond Mohn Foundation (TMS2019TMT09).

      Informed Consent Statement: The Institutional Review Board (IRB) or equivalent ethics committee of Haukeland University Hospital approved the study protocol and publication of data. The patient(s) provided informed written consent for the publication of the study data.Date of approval 28/11/2018. Approval number: 2016/1132-8

      Central Picture: Simulations of moderate annular reductions versus conventional annuloplasty rings

      Central Message

      In silico analysis by 3D echocardiography have shown that moderate annuloplasty ring scaling secures the same leaflet coaptation area in the individual patient compared with post-operative findings.

      Perspective Statement

      In silico analysis in Barlow’s patients demonstrates that annuloplasty with only moderate annular reduction may be sufficient to achieve optimal coaptation as compared to conventional annuloplasty procedures. This novel method may prove helpful in pre-operative planning and selection of the ideal annuloplasty ring size.

      Identification

      DOI: https://doi.org/10.1016/j.xjon.2023.01.007

      Copyright

      © 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery

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