Abstract
Background Optimal surgical treatment of functional ischemic mitral regurgitation (FIMR) is
still controversy. Due to the underlying pathophysiology, stand-alone ring annuloplasty
is assumed with a high recurrence rate of mitral regurgitation, thus additional subvalvular
repair techniques might improve the results. This in vitro study introduces a new
device for subvalvular mitral valve repair.
Methods We developed a new device for subvalvular mitral valve repair, consisting of two
frames for papillary muscle (PM) attachment, which are connected with two holding
bars serving for fixation of the device on an annuloplasty ring. In the first experimental
run, porcine mitral valves including the chordae tendineae and PMs were fixated on
a holding device, consisting of a holding ring simulating mitral annulus dilation
and height-adjustable frames for PM attachment simulating leaflet tethering. In vitro
regurgitant volume was determined in a pulse duplicator. Afterward, the frames for
PM attachment were replaced by our newly developed device and the measurements were
repeated.
Results In the model simulating FIMR, the regurgitant volume was 44.3 ± 12.38 mL/stroke.
After subvalvular reconstruction with our new device, the regurgitant volume was significantly
reduced to 33.1 ± 11.68 mL/stroke (p = 0.009).
Conclusion In this specific in vitro model, our new device for subvalvular mitral valve reconstruction
led to a significant reduction of the regurgitant volume, thus representing a promising
technique to potentially improve the results of mitral reconstruction in ischemic
functional mitral valve regurgitation. Additional studies are required to further
investigate and improve our device.
Keywords
heart valve surgery - mitral valve surgery - ischemic mitral regurgitation - in vitro
