Mitral Reconstruction Research Articles

Midterm results after seamless patch mitral reconstruction.

Some pathologies, including infective endocarditis or sclerotic changes of the mitral leaflet, make the conventional mitral valve repair challenging. Our previously described technique for reconstruction with a seamless pericardial patch makes the repair feasible in some of such difficult pathologies. However, the extent of mitral leaflet segments that could be safely repaired using this technique remains unknown. We investigated the association between the midterm outcome and the extent of mitral leaflet segments replaced by a pericardial patch. From January 2009 to January 2022, patients who underwent mitral valve repair with the seamless 1-patch reconstruction technique were included. The glutaraldehyde-treated pericardium was trimmed and anchored at the papillary muscle. The edge was sewn to the leaflet and the annulus. A total of 49 patients (aged 60±15years) underwent mitral valve repair with this technique. The totally endoscopic approach was used in 27 patients (55%). No patient's repair was converted to valve replacement. No operative mortality or disabling stroke was observed during the early postoperative period. In the midterm follow-up, redo surgery was required in 9 patients (18%). Freedom from mitral valve reintervention rates at 1, 5, and 10years were 84%, 82%, and 82% for all patients, respectively. Freedom from reoperation at 5years was 100%, 92%, and 46% for commissural lesion, 1- to 2-segment involvement, and 3-segment involvement, respectively. There was a significant difference among the 3 groups with regard to mitral valve reoperation rate (P=.002). Mitral valve seamless patch reconstruction provides excellent midterm results if applied to commissural lesions or lesions involving up to 2 segments.

Augmentation of the posterior mitral leaflet in secondary mitral valve insufficiency, mid-term results.

We evaluate the mid-term results of mitral valve (MV) repair with patch augmentation of the posterior leaflet in secondary mitral regurgitation. Patients were included after diagnosis of a severe symptomatic secondary MV insufficiency with grade III and IV according to the Carpentier classification IIIb. Indication for a patch augmentation technique was a dilatation of the left ventricle leading to a displacement of the papillary muscles, causing restricted leaflet motion and a marked leaflet tenting height. Data were collected prospectively between December 2011 and March 2020. In total, 174 patients (mean age: 65 ± 12 years) received an MV repair with patch augmentation of the posterior leaflet and a true-sized remodelling annuloplasty (mean size 30.8 mm). Causes of the MV incompetence were dilatative cardiomyopathy in 126 patients and ischaemic myocardial disease in 48 patients. Concomitant bypass surgery was performed in 28 patients, and the tricuspid valve was repaired in 68 patients. The mean follow-up was 40 ± 28.2 months. There was no 30-day mortality. In-hospital mortality was 1.2% (n = 2); late mortality was 10.9% (n = 19). At 8 years, overall survival was 62.48%, freedom from moderate or severe recurrent mitral regurgitation was 91.9% and freedom from reoperation due to MV insufficiency was 97.1%. Augmentation of the posterior MV leaflet in addition to remodelling annuloplasty is a safe and reproducible mitral reconstruction technique that renders sustainable MV competence.

Right ventricular dysfunction in patients with non-severe ischemic mitral regurgitation qualified to cardiosurgery treatment

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Right ventricular (RV) dysfunction worsens prognosis in patients (pts) after myocardial infarction (MI). Purpose The purpose of this study was to assess RV function as a predictor of mortality and hospitalizations due to exacerbation of HF in pts with ischemic mitral regurgitation (IMR) qualified for cardiosurgical treatment - coronary artery by-pass grafting alone (CABGa) or CABG with mitral reconstruction (CABGmr). Methods We prospectively analyzed 104 pts (M 57, 64 ± 7 years) with non-severe IMR, 3-24 weeks after MI. Effective regurgitation orifice (ERO) was used for quantitative IMR assessment (non-severe ≥10-20 mm²). All the pts were qualified for CABG (multiple vessel coronary disease, ejection fraction (EF)-44 ± 8%). The patients were referred for CABGa (gr.1; n = 77) or CABGmr (gr.2; n = 27) based on clinical assessment, 2D and 3D echo at rest and exercise. Tricuspid annular plane systolic excursion (TAPSE) was acquired to evaluate RV function (measured with M-mode imaging in the 4-chamber view). RV function was related to clinical outcome (median follow-up: 12 months). Results During the follow-up period of 12 months, 5 deaths (5 %) and 8 hospitalizations (8%) due to exacerbation of HF occurred. With use of the following cut-off points of TAPSE ≤ 12 mm (group I), and TAPSE >12 mm (group 2)—an association was found between the lower TAPSE and increased mortality. In group 1 (n =54 pts), 5 pts (9.2%) died and 6 pts was hospitalized due to HF (11.1%); in group 2 (n =50), no patient died, and 2 pts was hospitalized (4%). There was a significant difference (p = 0.02) in clinical outcomes between group I and II. ROC analysis identified TAPSE ≤12 mm as predictive cut-off for prediction adverse clinical outcome in all study group: (death: sensitivity 80%, specificity 76%, area under curve [AUC] = 0.807 (Fig.1); death and HF hospitalizations: sensitivity 69%, specificity 79%; AUC =0.767). Conclusion TAPSE is simple and useful quantitative measurement of RV function and have a predictive value in pts with non-severe IMR referred for cardiosurgery treatment. Abstract Figure 1

MitraClip: a word of caution regarding an all too liberal indication and delayed referral to surgery in case of failure.

Although indications for the MitraClip are becoming increasingly liberal, the number of patients requiring valve surgery after an insufficient outcome of the procedure is growing. Referral to surgery is, however, frequently delayed. During this time, the patients often deteriorate. We retrospectively analysed patients before MitraClip implantation and after mitral valve surgery. A total of 49 patients who received a mitral valve replacement (average 8 ± 12 months after MitraClip implantation) were assessed. Of these, 53% had 2-4 clips inserted. The mean age was 73 years, and the mean log EuroSCORE was 20.79 ± 14.42%. Echocardiographic data obtained prior to MitraClip implantation and preoperatively, 10 days and 6 and 12 months after cardiac surgery were reviewed. Survival analysis, risk profile and postoperative complications were analysed. The 30-day and 1-year mortality was 26.5% and 59.2%, respectively. Prior to MitraClip implantation, 42.8% of patients had mild tricuspid insufficiency and 6.1% had moderate tricuspid insufficiency. Prior to surgery, 26.5% showed mild, 32.7% moderate and 38.8% severe tricuspid insufficiency (P < 0.001). Furthermore, right heart function assessed by tricuspid annular plane systolic excursion deteriorated significantly after Implantation of the MitraClip (P < 0.001). In patients with a MitraClip, the pulmonary artery pressure was significantly higher at the time of mitral replacement than it was before the MitraClip was implanted (P < 0.001). A subgroup of patients does not benefit from a MitraClip and shows progressive deterioration in cardiac function, making valve replacement under difficult circumstances inevitable. The earlier these patients are operated on, the better it is. It can be assumed that some patients would be better off with primary surgery, especially if mitral reconstruction is then still feasible. Therefore, the indications for MitraClip implantation should be carefully considered and caution should be exercised during monitoring.

Interactive editing of virtual chordae tendineae for the simulation of the mitral valve in a decision support system

PurposeDecision support systems for mitral valve disease are an important step toward personalized surgery planning. A simulation of the mitral valve apparatus is required for decision support. Building a model of the chordae tendineae is an essential component of a mitral valve simulation. Due to image quality and artifacts, the chordae tendineae cannot be reliably detected in medical imaging.MethodsUsing the position-based dynamics framework, we are able to realistically simulate the opening and closing of the mitral valve. Here, we present a heuristic method for building an initial chordae model needed for a successful simulation. In addition to the heuristic, we present an interactive editor to refine the chordae model and to further improve pathology reproduction as well as geometric approximation of the closed valve.ResultsFor evaluation, five mitral valves were reconstructed based on image sequences of patients scheduled for mitral valve surgery. We evaluated the approximation of the closed valves using either just the heuristic chordae model or a manually refined model. Using the manually refined models, prolapse was correctly reproduced in four of the five cases compared to two of the five cases when using the heuristic. In addition, using the editor improved the approximation in four cases.ConclusionsOur approach is suitable to create realistically parameterized mitral valve apparatus reconstructions for the simulation of normally and abnormally closing valves in a decision support system.

Gasparyan Method of Total Autologous Reconstruction of the Mitral Valve: Case Report

In this case report we present our first clinical experience of total autologous reconstruction of the mitral valve using the technique, described in the experimental study of Dr. Gasparyan. This is a stentless, autologous valve - a very good alternative for the prosthetic valves in those cases when the mitral valve repair is not possible and its replacement is not desirable. This technique of the mitral valve reconstruction is reproducible and 3 months follow up results are encouraging. Key Words: mitral; valve; reconstruction; mitral reconstruction; autologous pericardium

P325 Inadequate inhibition of platelet function after exercise in patients with ischemic mitral regurgitation qualified for cardiosurgery treatment

Abstract Purpose Human platelets play a major role in the pathophysiology of cardiovascular diseases. The aim of our study was to determine the relationship between exercise and level of platelet inhibition in patients (pts) after myocardial infarction (MI) with at least moderate ischemic mitral regurgitation (IMR) qualified for cardiosurgical treatment - coronary artery bypass grafting alone (CABG) or CABG with mitral reconstruction (CABGmr). Methods We collected venous blood samples from 70 pts (M 41, 66 ± 9 years) with at least moderate IMR, 3-24 weeks after MI. Platelet reactivity was estimated with the use of rapid, point-of-care platelet analyzer as the time for flowing whole blood to occlude a collagen-epinephrine ring, with shorter closure times (CEPI-CT), indicating greater activity. CEPI-CT was evaluated before (CEPI-CT rest) and 20 min after ExE (CEPI-CT ExE). Inadequate inhibition of the TXA2-dependent activation pathway was defined as CEPI-CT &amp;lt; 193 seconds. All the patients received 75-100 mg of aspirin daily (without clopidogrel treatment). Effective regurgitation orifice (ERO) was used for quantitative IMR assessment (moderate ≥10-20, severe ≥ 20 mm²). In all pts symptom-limited echocardiography (echo) semi-supine exercise test (ExE) was performed with Schiller system. All the pts were referred for CABG (multivessel coronary disease, ejection fraction (EF) 42,6 ± 10,1%, wall motion score index (WMSI) 1.65 ± 0.36). Results We observed inadequate platelet in 26 (37%) pts at rest (CEPI-CT &amp;lt; 193 sec., despite regular aspirin therapy) and in 48 (68%) pts in 20 min. after exercise. We observed a significant decrease in CEPI–CT in all analyzed group (rest vs exe: 202 sec. vs 124 sec., respectively; p &amp;lt; 0,0001) and also in pts with moderate IMR as well as with severe IMR. We didn’t observe a significant change in platelet count and mean platelet volume (MPV) between rest and exercise. Conclusions: 1. Inadequate antiplatelet effect of aspirin at rest was observed in 37% pts after MI with IMR. 2. Symptoms limited exercise test has revealed inadequate platelet inhibition (TXA2 –dependent activation pathway) in 68% of patients after MI with IMR. 3. Aspirin may have a limited antithrombotic effect after physical exercise in patients after MI with significant IMR.

P1786 Impact of exercise on platelet activity in patients with significant ischemic mitral regurgitation qualified for cardiosurgery treatment

Abstract Purpose Platelet activity is believed to play an important role in patients (pts)after myocardial infarction (MI). This study sought to examine a change in platelet activity after 2D echocardiography semi-supine exercise test (ExE) in pts with at least moderate ischemic mitral regurgitation (IMR) qualified for cardiosurgical treatment - coronary artery bypass grafting alone (CABG) or CABG with mitral reconstruction (CABGmr). Methods We collected venous blood samples from 70 patients (M 41, 66 ± 9 years) with at least moderate IMR, 3-24 weeks after MI. Platelet activity was estimated with the use of rapid, point-of-care platelet analyzer as the time (in seconds) for flowing whole blood to occlude a collagen-epinephrine ring, with shorter closure times, indicating greater activity (CEPI-CT- for assessing the thromboxane A2 –dependent activation pathway). CEPI-CT was evaluated before (CEPI-CT rest) and 20 min after ExE (CEPI-CT ExE). All the patients received 75-100 mg of aspirin daily (without clopidogrel treatment). Effective regurgitation orifice (ERO) was used for quantitative IMR assessment (moderate ≥10-20, severe ≥ 20 mm²). All the pts were referred for CABG (multivessel coronary disease, ejection fraction (EF) 42,6 ± 10,1%, wall motion score index (WMSI) 1.65 ± 0.36). Results We observed a significant decrease in CEPI–CT’s in all analyzed group (rest vs exe: 202 sec vs 124 sec, respectively; p &amp;lt; 0,0001) and in pts with moderate IMR as well as in pts with severe IMR, despite aspirin treatment. The results of the analysis of CEPI-CT and IMR size at rest and after ExE in both groups of pts are shown in Table 1. A negative correlation was found between CEPI-CT ExE and ERO ExE (r=-0,752, p = 0,0042). Conclusions 1. Significant increase in platelet activity after exercise was observed in patients after MI with IMR qualified for cardiosurgical treatment. 2. The increase in platelet activity after exercise is correlated with exercise changes of IMR size. 3. Aspirin may have a limited antithrombotic effect after physical exercise in patients after MI with significant IMR. Table 1. CEPI-CT rest CEPI-CT ExE p ERO rest ERO exe p All 202 124 &amp;lt; 0,0001 17 22 &amp;lt;0,001 Moderate IMR 201 124 0,0001 15 20 &amp;lt; 0,0001 Severe IMR 235,5 123,5 &amp;lt; 0,0001 25 31 &amp;lt; 0,0001

Entire mitral reconstruction with porcine extracellular matrix in an acute porcine model

ObjectiveThe objective of our study was to investigate the feasibility of reconstructing the entire mitral valvular and subvalvular apparatus in pigs using a modified tube graft design made of 2-ply small intestinal submucosa extracellular matrix. MethodsThe reconstructions were performed in an acute 80-kg porcine model with 8 pigs, each acting as its own control. A modified tube graft was designed from a sheet of 2-ply small intestinal submucosa extracellular matrix. Before and after mitral valve reconstruction, echocardiography was used to assess mitral regurgitation, left ventricular outflow tract obstruction due to systolic anterior motion, mitral stenosis, leaflet mobility, and leaflet geometry. ResultsThe reconstructed mitral valves were fully functional without any observable echocardiographic signs of regurgitation. We did not observe any left ventricular outflow tract obstruction due to systolic anterior motion nor any mitral valve stenosis, despite a diminished septal-lateral distance after reconstruction. The reconstruction had a reduced tenting area, a reduced coaptation length (9.6 ± 1.7 mm vs 7.9 ± 1.0 mm, P = .010, diff = −1.7 mm, 95% confidence interval, −3.1 to −0.4 mm), and atrial bending of both leaflets. ConclusionsIn this acute porcine study, entire mitral valvular and subvalvular apparatus reconstruction using a modified tube graft design made from 2-ply small intestinal submucosal extracellular matrix was feasible. The 2-ply small intestinal submucosa extracellular matrix could withstand the pressure exerted by the left ventricle without any signs of tearing or rupture. These promising results warrant further assessment of both the annular geometry and the long-term durability.

New Device for the Treatment of Functional Ischemic Mitral Regurgitation: Proof of Concept in an In Vitro Model.

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. 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. 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). 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.

INFECTIOUS ENDOCARDITIS CAUSED BY A RARE AGENT BURKHOLDERIA CEPACIAN

Introduction. Infectious endocarditis (IE) caused by microorganisms Burkholderia cepacia is a very rare and poorly characterized form of endocarditis.Material and methods. We observed a case of late prosthetic mitral valve IE caused by Burkholderia cepacia in a 34-year-old patient.Results. A patient with a congenital ventricular septum defect underwent surgery on the heart three times in past, including the resection of mitral valve vegetations due to IE at age 17 and mitral valve replacement plus ventricular septum defect plastic reconstruction at 33 years old. The last was complicated by postoperative purulent sterno-mediastenitis treated by thoracoplasty. 10 months later the fever with chills appeared again, a large vegetation on a mitral valve prosthesis was revealed, and Burkholderia cepacia bacteremia with multidrug resistance to antibiotics was find. After the start of treatment with trimethoprim / sulfamethoxazole, normal temperature was observed, but the course of IE was complicated by thromboembolism with a fatal outcome.Conclusions. Multidrug resistance of the pathogen to antibiotics, including those empirically prescribed for IE, is the main risk factor for the adverse outcome of IE caused by Burkholderia cepacia. The lack of generally accepted recommendations determining the doses of antibiotics prescribed in accordance with the microorganism sensitivity is the problem still present in Burkholderia cepacia IE treatment.

Second cross-clamping after mitral valve repair for degenerative disease in contemporary practice.

Scanty data are available on 'second cross-clamping' following mitral valve repair in contemporary practice. The aim of this study was to evaluate the incidence, causes and outcomes of this event in patients referred for mitral repair for severe degenerative mitral regurgitation (MR). The study population included 2318 patients with severe degenerative MR referred for mitral repair. A second cross-clamping was performed in 94 (4%) patients. Causes of the second cross-clamping, revising repair procedures, immediate echocardiographic outcomes and postoperative course were assessed and compared with the 'single cross-clamping cases' (2224 patients used as control). Clinical and echocardiographic follow-up information was available for 91 of the 94 second cross-clamping patients (97% complete) (median time 6 years, interquartile range 3-11). The most frequent causes of the second cross-clamping were residual MR >1+/4+ and systolic anterior motion. A residual prolapse was identified in 41 (43.5%) patients, systolic anterior motion in 22 (23.5%), untreated clefts in 14 (15%) and other mechanisms in 17 (18%). Second cardiopulmonary bypass and aortic cross-clamping times were 36 (range 28-50) and 23 (range 17-34) min, respectively. Hospital mortality was 0% in the second cross-clamping and 0.3% in the control group (P = 0.2). Postoperative complications and length of hospital stay were similar. At discharge, residual MR ≥2+/4+ was 2.1% in the second cross-clamping and 2.7% in the control group (P = 0.99). In the second cross-clamping, at 12 years, the cumulative incidence function of reoperation, recurrent MR ≥3+ and MR ≥2+ with death as competing risk were 5.7 ± 2.5% (95% confidence interval 2-12), 10.3 ± 4.3% (95% confidence interval 3.8-20) and 17 ± 5.2% (95% confidence interval 8-29), respectively. In a large volume centre for mitral repair, a second cross-clamping is still performed in 3-5% of the patients. Because suboptimal immediate results are associated with impaired late outcomes of mitral reconstruction, a low threshold for a second cross-clamping seems to be justified. If the second repair is carried out with a relatively shorter additional cross-clamping time, mortality and morbidity are not increased and immediate and long-term results are very satisfactory.

A successful treatment of ischemic cardiomyopathy associated with left ventricular aneurysm and chronic ischaemic mitral regurgitation (RCD code: III-1B.9.o).

Complications of myocardial infarction (MI) such as left ventricular aneurysm, chronic ischaemic mitral regurgitation (CIMR) and heart failure are associated with a poor prognosis. The management of complex defects is challenging and requires an individualized strategy. We describe a case of 44-year-old male with multiple complications of MI including heart failure with reduced ejection fraction, left ventricular aneurysm and severe CIMR. We present complex approach, aimed at correcting various components of ischemic cardiomyopathy: relieving ischemia, reducing left ventricular wall tension, reducing volume overload and pulmonary hypertension by mitral valve surgery and left ventricular reconstruction (also known as the Dor procedure). In this case report, we describe the crucial role of echocardiography and magnetic resonance imaging before surgery.

TCT-41 Up to two years follow up results of mitral valve transcatheter annuloplasty system for mitral reconstruction multi-center trial

TCT-41 Up to two years follow up results of mitral valve transcatheter annuloplasty system for mitral reconstruction multi-center trial

CRT-400.16 Transfemoral System for Mitral Valve Reconstruction - A Multicentre Experience

Cardioband system enables percutaneous implantation of an adjustable “surgical-like” device for mitral reconstruction and MR reduction using a transseptal approach. The aim of this multi-center study was to evaluate the feasibility, safety and up to 12 month outcome of Cardioband in patients

弁輪部高度破壊を伴った僧帽弁位人工弁感染の1手術例

弁輪部高度破壊を伴った僧帽弁位人工弁感染の1手術例

Guided Functional Re-Engineering of the Mitral Valve Leaflets

Valvular heart disease is a major cause of mortality worldwide. Mitral valve regurgitation represents the second major valvular disorder in the western world. Current strategies for mitral valve reconstruction are imperfect. The aim of this study was to investigate the tissue engineering of mitral valve leaflets for mitral valve leaflets reconstruction. The approach taken was to utilise decellularised porcine pericardium seeded with porcine mesenchymal stem cells (pMSCs) and to mechanically condition the cell seeded constructs using biaxial strain in a bespoke bioreactor. The biomechanical and biological properties of porcine mitral valve leaflets and native and decellularised porcine pericardium were studied for comparative purposes. The porcine pericardium was decellularised using a propriety method based upon low concentration sodium dodecyl sulphate (SDS) and proteinase inhibitors. Histological characterisation showed the four and three layered structure of leaflets and fresh/decellularised pericardium, respectively. Histological analysis of decellularised pericardium did not reveal any remaining cells. Moreover, the histoarchitecture of collagen and elastic fibres appeared to be well preserved. Biochemical analysis showed that the mitral valve leaflets and the fresh pericardium had hydroxyproline and glycosaminoglycan (GAG) contents similar to those reported in the literature. Decellularised pericardium had higher hydroxyproline content than that of fresh pericardium but lower GAG content. The levels of deoxyribonucleic acid (DNA) in fresh and decellularised pericardium were determined and this showed that there was a 99% reduction in the DNA content following decellularisation. In vitro biocompatibility studies showed that the decellularised pericardium was not cytotoxic to porcine skin fibroblasts and pMSCs. Biomechanical properties were determined using low strain rate uniaxial loading to failure. Both fresh and decellularised pericardium demonstrated rather isotropic behaviours, possessing similar mechanical properties along the two orthogonal directions studied. Anterior leaflet specimens cut circumferentially were stiffer than those cut radially and the posterior leaflets. This anisotropic mechanical behaviour of the anterior leaflet was related to the main orientation of the collagen fibres along the circumferential direction. Conversely, the posterior leaflets were more isotropic. The optimum seeding density for culturing decellularised pericardial samples was 1×105 cells·cm-2 for pMSCs and the ideal time for culturing prior to loading the reseeded scaffold in the bioreactor stations was 3 days. With regards to fibroblasts and porcine smooth muscle cells (pSMCs), the optimum seeding density was 2×105 cells·cm-2 at 1 week culture for fibroblasts, whereas pSMCs had the tendency of forming agglomerates on the surface of tissue rather than penetrating throughout the thickness of the scaffold, thus, they were not considered ideal for remodelling the histoarchitecture of tissue during dynamic experiments. The actuator of the bioreactor was calibrated and the general set up of the system was completed. Suitable conditions to apply during static culture in the bioreactor, in terms of oxygen and pH control, in order to maintain the ECM integrity and cell viability in the bioreactor, were initially determined using fresh pericardium, however this proved problematic due to the variability in the tissue that was available. One day static experiment performed with the bioreactor by using decellularised pericardium reseeded with pMSCs showed that there was no difference in terms of viability when keeping the tissue statically in the tissue holders and in the bioreactor stations. Thus, tissue holders could be used as positive static controls during dynamic experiments. One day dynamic experiments (10% strain) performed with the bioreactor by using decellularised pericardium reseeded with pMSCs showed that cells were viable both when kept dynamically in the bioreactor and statically in the tissue holders. Cells started aligning along specific directions when kept dynamically in the bioreactor. Overall porcine mitral valve leaflets and porcine fresh/decellularised pericardium shared similar histoarchitectures, but had different biochemical composition and biomechanics. Decellularised pericardium was shown to be an optimum material for cell repopulation, delivering the necessary biological and biomechanical cues to seeded cells. The bioreactor was optimised for both static and dynamic culture and is now ready for further investigation at longer time points. This research provided the basics into the optimal strategy for mechanostimulation of cell-seeded pericardial scaffolds in vitro in order to generate heart-valve like tissue.

The Year in Cardiology 2013: heart failure

Heart failure has become a worldwide epidemic of the 21st century with increasing impact on healthcare systems. The 2012 ESC and 2013 ACCF/AHA guidelines have set the stage for current therapy to reduce mortality and morbidity. There is a dawn of hope for therapy of acute and diastolic heart failure; it has become clearer that patients benefit from mitral reconstruction and which patients benefit from heart failure management programmes; genetics and proteomics advance in great strides; competing concepts of cell therapy seem to spiral, hopefully upwards; and we can further nurture our hope for evidence-based individualized diagnostic and therapy.

TRANSVENTRICULAR SUTURAL SEGMENTAL ANNULOPLASTY OF POSTERIOR MITRAL VALVE SEMI-CIRCUMFERENCE AS A VARIANT OF TRANSGASTRIC CORRECTION OF ISCHEMIC MITRAL REGURGITATION IN PATIENTS WITH POSTINFARCTION LEFT VENTRICULAR ANEURISM

Aim. To choose the method of correcting a moderate ischemic mitral regurgitation (IMR) in patients with ischemic cardiomyopathy is an actual task of modern cardiosurgery. Materials and methods. The results of treatment of 75 patients with chronic postinfarction left ventricular aneurysm (CLVA) and moderate annuloectasia-caused ischemic mitral regurgitation operated in 2007–2008 were studied. Results. All patients underwent coronary shunting, left ventricular aneurysm resection with Dor’s remodeling, 26 patients – transventricular sutural segmental annuloplasty of posterior mitral valve semi-circumference, 49 – mitral ring annuloplasty. The obtained results (three-year observation period) prove the comparable efficiency of both mitral reconstruction techniques used for liquidation of a moderate ischemic mitral regurgitation. Conclusion. The procedure of transventricular sutural segmental annuloplasty of posterior semi-circumference of the mitral valve (MV) is easy to perform and provides satisfactory hemodynamic indices.

How to prevent SAM in mitral valve reconstruction

Methods We present a retrospective study on 120 cases with degenerative mitral regurgitation in which surgical mitral reconstruction has been tried in the last 5 years. 29 Barlow diseases, 50 FED, 20 idiopathic calcification of PML. Preoperative echographic and intraoperative valve analysis reveals risks factors for SAM; small LV, bulging septum, redundant leaflets, reduced mitro aortic angle, anterior coaptation line. All patients were operated with classical approach, median sternotomy, CEC, standard techniques for mitral valve reconstruction. Surgical methods for SAM prevention are; rings of corresponding dimensions, avoidance of large quadrangular resections, reconstruction of correct ratio between PML and AML dimensions by annular sliding; for large PML prefers the chordae insertion or butterfly resection.