Abstract
Purpose
To investigate the anatomical and functional effects of complete surgical reconstruction of the posterior mitral leaflet and associated chordae tendineae with a patch made of 2-ply small intestinal submucosal extracellular matrix in vitro.
Methods
Seven explanted mitral valves with intact subvalvular apparatus from 80-kg pigs were evaluated in a left heart simulator and served as their own controls. After testing the native valve, the mitral posterior leaflet and associated chordae tendineae were excised and reconstructed by using the 2-ply small intestinal submucosa extracellular matrix patch. The characterization of the reconstruction was based on geometric data from digital images, papillary muscle force, annular tethering force and leaflet pressure force.
Results
The reconstructed valves were fully functional without regurgitation, tearing or rupture during incrementally increased pressure from 0 to 120 mmHg. The leaflet areas were preserved after reconstruction, with a normal configuration of the coaptation line. However, the coaptation midpoint moved posteriorly after reconstruction (A2: 15.8 ± 1.4 vs. 18.9 ± 1.5 mm, p = 0.002, diff = 3.1 mm, 95% CI 1.3 to 4.8 mm). The anterior papillary muscle force increased significantly (3.9 vs. 4.6 N, p = 0.029, diff = 0.7 N, 95% CI 0.1 to 1.4 N at 120mmHg) after reconstruction. The posterior papillary muscle force, leaflet pressure force and annular pressure force did not change significantly.
Conclusions
In this in vitro model, mitral valve anatomy and function were comparable between the native mitral valve and our new surgical technique for complete reconstruction of the posterior mitral leaflet and associated chordae tendineae. These promising results warrant further in vivo evaluation.
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Acknowledgments
This work was supported by the Lundbeck Foundation [Grant Number R184-2014-2478], the Danish Heart Foundation [Grant Numbers 16-R107-A6588-22041 and 16-R107-A6588-22042], the Graduate School of Health, Aarhus University [Grant Number 18931909], the Helga and Peter Korning Foundation and the Raimond and Dagmar-Ringgaard Bohn Foundation. The 2-ply small intestinal submucosal extracellular matrix material was donated by CorMatrix®.
Conflict of interest
Author Marcell J. Tjørnild, Author Søren W. Sørensen, Author Lisa Carlson Hanse, Author Søren N. Skov, Author Diana M. Røpcke, Author Sten L. Nielsen and Author J. Michael Hasenkam all declare that they have no conflict of interest.
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Tjørnild, M.J., Sørensen, S.W., Carlson Hanse, L. et al. Mitral Valve Posterior Leaflet Reconstruction Using Extracellular Matrix: In Vitro Evaluation. Cardiovasc Eng Tech 11, 405–415 (2020). https://doi.org/10.1007/s13239-020-00472-0
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DOI: https://doi.org/10.1007/s13239-020-00472-0