Mitral Valve Reconstruction Research Articles

Comprehensive patient-specific information preprocessing for cardiac surgery simulations.

Patient-specific biomechanical simulations of the behavior of soft tissue gain importance in current surgery assistance systems as they can provide surgeons with valuable ancillary information for diagnosis and therapy. In this work, we aim at supporting minimally invasive mitral valve reconstruction (MVR) surgery by providing scenario setups for FEM-based soft tissue simulations, which simulate the behavior of the patient-individual mitral valve subject to natural forces during the cardiac cycle after an MVR. However, due to the complexity of these simulations and of their underlying mathematical models, it is difficult for non-engineers to sufficiently understand and adequately interpret all relevant modeling and simulation aspects. In particular, it is challenging to set up such simulations in automated preprocessing workflows such that they are both patient-specific and still maximally comprehensive with respect to the model. In this paper, we address this issue and present a fully automated chain of preprocessing operators for setting up comprehensive, patient-specific biomechanical models on the basis of patient-individual medical data. These models are suitable for FEM-based MVR surgery simulation. The preprocessing methods are integrated into the framework of the Medical Simulation Markup Language and allow for automated information processing in a data-driven pipeline. We constructed a workflow for holistic, patient-individual information preprocessing for MVR surgery simulations. In particular, we show how simulation preprocessing can be both fully automated and still patient-specific, when using a series of dedicated MVR data analytics operators. The outcome of our operator chain is visualized in order to help the surgeon understand the model setup. With this work, we expect to improve the usability of simulation-based MVR surgery assistance, through allowing for fully automated, patient-specific simulation setups. Combined visualization of the biomechanical model setup and of the corresponding surgery simulation results fosters the understandability and transparency of our assistance environment.

UP TO ONE-YEAR FOLLOW-UP RESULTS FROM A MULTICENTER TRIAL OF A TRANSFEMORAL SYSTEM FOR MITRAL VALVE RECONSTRUCTION

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

Accuracy evaluation of a mitral valve surgery assistance system based on optical tracking.

Mitral valve reconstruction is a widespread surgical method to repair incompetent mitral valves, which usually includes implantation of a ring prosthesis. To date, intraoperative analysis of the mitral valve is merely based on visual assessment using simple surgical tools, which might not allow for accurate assessment of the complex anatomy. We propose a novel intraoperative computer-based assistance system, which combines passive optical tracking technology with tailored measurement strategies applicable during different phases of the intraoperative workflow. Based on the assessment of the valvular apparatus by customized tracked instruments, the system (1)generates an enhanced three-dimensional visualization, which (2) incorporates accurate quantifications and (3) provides assistance, e.g., in terms of virtual prosthesis selection. Phantom experiments in a realistic environment revealed a high system accuracy (mean precision [Formula: see text]mm and mean trueness [Formula: see text]mm) and a low user error (mean precision [Formula: see text]mm and mean trueness [Formula: see text]mm). The assistance system was successfully applied five times during open and minimally invasive reconstructive surgery in patients having mitral valve insufficiency. The measurement steps integrate well into the traditional workflow, enhancing the surgeon's three-dimensional perception and generating a suggestion for an appropriate prosthesis. The proposed assistance system provides a novel, accurate, and reproducible method for assessing the valvular geometry intraoperatively.

SURGICAL TREATMENT OF COMPLEX ARRHYTHMIAS IN PATIENTS WITH NON-ISCHEMIC MITRAL INSUFFICIENCY

Aim: To analyze and improve efficacy of surgical treatment of patients with non-ischemic mitral insufficiency and atrial fibrillation. Materials and methods: The study included 64 patients with degenerative mitral insufficiency complicated by atrial fibrillation who had surgical interventions from 2011 to 2014. Surgical treatment consisted of surgical correction of mitral regurgitation: mitral valve reconstruction (group 1, n = 133) and mechanical prosthesis (group 2, n = 31), as well as left atrium Maze IV procedure in “box lesion” modification with the use of AtriCure bipolar destructor in both groups. Results: No postoperative deaths were registered. After surgery, all patients showed a decrease in all cardiac cavities’ sizes and of pulmonary hypertension, an improvement in left ventricular systolic function assessed by transthoracic echocardiography. During follow-up of up to 14 months’ duration, sinus rhythm was maintained in 56 (86%) of patients, whereas 9 patients had recurrent atrial fibrillation resistant to medications and electrical cardioversion. Patients, who had undergone valve preserving correction of mitral insufficiency and left atrium Maze IV procedure, had the best results as to contractility of left ventricle (7.86%), reduction of cardiac cavities’ size (end-diastolic dimension – 11.05%, end-systolic dimension – 15.15%, right atrium – 15.19%), especially that of left atrium (19.03%), reduction of pulmonary hypertension (27.75%) and significant improvement in quality of life (7 points) assessed by Minnesota Living with Heart Failure Questionnaire. Conclusion: Plastic correction of mitral insufficiency with atrial fibrillation combined with Maze IV procedure gives the highest improvement of left ventricular contractility and diminishing of cavities compared to mitral valve replacement with mechanical prosthesis in combination with Maze IV procedure.

Left Ventricular Remodelling after Mitral Valve Reconstruction: a 1-year Prospective cMRI Study

Left Ventricular Remodelling after Mitral Valve Reconstruction: a 1-year Prospective cMRI Study

Inter-observer Agreement and Variability Using 3D Echocardiography Based Mitral Valve Reconstruction

Background: Ticagrelor is an oral, direct, reversible noncompetitive P2Y12 receptor antagonist with rapid and consistent onset and offset of action. The time course of recovery of platelet function following ticagrelor cessation in patients presenting with acute coronary syndrome (ACS) and undergoing surgical revascularisation is yet to be determined. Current guidelines recommend stopping ticagrelor at least 5 days before coronary artery bypass grafting (CABG). However a shorter plasma half-life of ticagrelor (7-12 hours) suggests that this may be longer than necessary. Methods: 46 consecutive ACS patients, who were commenced on aspirin (100 mg) and ticagrelor(180 mg loading and then 90mg twice a day), were referred for CABG after coronary angiography. Immediately after angiography, ticagrelorwas discontinued and inhibition of platelet aggregation (IPA) was assessed daily using the Verify Now P2Y12 assay. Results: Themean agewas 62.37 ( 9.28) years, 78%males. 44% were diabetic. ACS presentations were non ST-elevation myocardial infarction 72%, ST-elevation myocardial infarction 9% and unstable angina 19%. The percentage of patients with IPA 40%) prior to discontinuation. Platelet function recovered by day 3 with 96% recording less than 20% residual IPA (p<0.0001). No significant rebound was noted. Conclusion: The offset of the anti-platelet effects of ticagrelor after its discontinuation in patients with ACS is achieved by day 3. This data suggests an earlier surgical revascularisation strategy than currently recommended in guidelines can be considered.

2015 4thTERMIS World CongressBoston, MassachusettsSeptember 8–11, 2015

2015 4^thTERMIS World CongressBoston, MassachusettsSeptember 8–11, 2015

Complete Balanced Atrioventricular Septal Defect – Results of Bi-ventricular Surgical Correction

Aim. The aim of this study was to analyze the results of surgical treatment of balanced AVSD during 10-year period in a single center. The adequacy of atrioventricular valves reconstruction was scrutinized as well as risk factors for mortality, redo surgery, pulmonary hypertension incidence were assessed.Materials and method. One hundred twenty one patients underwent surgical correction of AVSD between 2004 and 2013. All patients were operated by double patch technique with the apposition zone closure. Patients’ median age was: 109 (86–151) days, body weight: 4.5 (4–5.5) kg. Down syndrome was present in 100 (82.6%) patients. Results. Early mortality equaled 17.3% (21 patients) and late mortality was 1.7% (2 patients). Pulmonary hypertension (42.9%) and heart failure (33.3%) were the main causes. Cardiopulmonary bypass time (p &lt; 0.0001), aortic cross-clamping time (p = 0.003), inotropic index value (p &lt; 0.0001), maximal mean pulmonary artery pressure (p = 0.008) were significantly higher in the group of patients who died. Ten patients (8.3%) required early reoperation and nine (9%) required late reoperation. Early postoperative mitral valve regurgitation of III-rd or higher degree was risk factor for early and late reoperations (p = 0.0002). The probability of freedom from all reoperations at 6 months, 1 and 5 years was respectively: 0.83; 0.80 and 0.71.Conclusions. Pulmonary hypertension and low cardiac output syndrome have significant influence on results of AVSD treatment. The predisposing risk factors are prolonged time of surgical procedure and presence of pneumonia. Mitral valve reconstruction quality has an influence for early and late results.

Contemporary long-term outcomes of an aggressive approach to mitral valve repair in children: is it effective and durable for both congenital and acquired mitral valve lesions?

We analysed the long-term outcomes of mitral valve (MV) repair in children and compared the repairs for both congenital and acquired lesions. A review of 634 children (≤18 years) who underwent MV repair from 1992 to 2011 was conducted [excluding patients with complete atrioventricular septal defect (AVSD), single ventricle and atrioventricular (AV) discordance]. Associated cardiac anomalies were present in 473 patients (75%). Congenital mitral lesions were found in 270 (43%) patients compared with an acquired aetiology in 364 (57%) [mainly rheumatic: 329 patients (90%)]. Mitral regurgitation (MR) was predominant in 606 (96%) patients, and 544 (86%) of these showed ≥3+ MR. Modified techniques of MV reconstructions were used. The early mortality rate was 2% (14 patients). The mean follow-up was 55 months (1-240 months; 85% complete). The late mortality rate was 4% (23 patients) and survival rates at 10 and 15 years were 91 and 86%, respectively. There was no significant difference in 10-year survival between repairing the congenital (98%) and acquired lesions (87%) (P = 0.17). The rate of freedom from reoperation after MV repair for the entire population was 79% at 10 years, with no significant difference between congenital (80%) and acquired lesions (79%) (P = 0.20). Fifty-six patients (9%) required reoperation. Mixed MV lesions, commissural fusions and residual MR (≥2+) were the predictors of valve failure and reoperation. All survivors remain in New York Heart Association class I and none had thromboembolism or pacemaker insertion. MV repair can be successfully applied to both congenital and acquired MV disease in children. Aggressive repair techniques and avoidance of residual MR have improved durability and survival.

Starting minimally invasive valve surgery using endoclamp technology: safety and results of a starting surgeon.

To critically review the learning curve, safety issues and outcome of a single surgeon while starting up minimally invasive mitral valve surgery (MIMVS). We performed a descriptive, retrospective study of 138 patients with minimally invasive mitral valve surgery between March 2004 and December 2010. The learning curve was assessed using a logarithmic curve-fit regression analysis of the cardiopulmonary bypass parameters and defined as the end of the steepest part. Complexity was assessed by the number of different techniques performed on the mitral valve and the number of concomitant procedures. Follow-up was obtained for embolic events, endocarditis, bleeding, reintervention, echocardiographic data and NYHA class. The learning curve was found in the last 30 cases. There was a significant reduction in aortic cross-clamp time before and after the end of the learning curve [Patients 1-30: 120.77 (±28.28); Patients 31-138: 97.57 (±5.66); P <0.0001]. Operations during the learning curve did not correlate with intensive care unit (ICU) [1.77 (±0.97) vs 2.06 (±1.38)] and hospital stay [10.00 (±2.74) vs 9.10 (±3.36)]. In 104 patients, the valve was reconstructed, whereas in 34 it was replaced. The complexity of mitral valve reconstruction gradually increased and proportion of mitral valve replacement decreased, partly by expanding minimally invasive mitral valve surgery indications. Eighteen patients underwent 25 concomitant procedures and four conversions were necessary (after Patient 30). Minimal follow-up was 1 year with a mean follow-up of 1211 ± 651 days. No procedure-related mortality was encountered and mitral regurgitation after mitral valve repair was classified as Grade 1 or less in 101 of 104 patients at the end of follow-up. Implementation of new equipment and techniques is challenging. However, minimally invasive mitral valve surgery with the endoclamp system is safe even during the learning curve. During our evolution from simple reconstructions/replacements to complex valve surgery with concomitant procedures, we could safely optimize our technique without mortality. A longer aortic cross-clamp time during the learning curve did not result in longer ICU and hospital stay.

Prof. Steven F. Bolling: why should we choose valve repair over replacement?

In the China Heart Congress 2014, Annals of Translational Medicine (ATM) has the honor to interview Dr. Steven F. Bolling (Figure 1), a renowned professor of Cardiac Surgery whose expertise in mitral valve repair continues to result in a large volume of referrals for mitral valve reconstruction. Dr. Steven F. Bolling’s innovative approach to mitral valve repair in patients with end-stage left ventricular failure and outstanding ability to repair even the most challenging mitral valve abnormalities have received wide spread international acclaim. He continues to run a National Institutes of Health (NIH)-funded basic science laboratory.

MitraClip-procedure with two Mitra-Clips after indirect anuloplasty with the MONARC-device

Mitral regurgitation is associated with a worsened prognosis in dilated cardiomyopathy. First standard therapy consists of a mitral valve reconstruction through heart surgery including heart lung machine. In patients with high co-morbidity, catheter-based techniques, have been developed. In the Evolution I study the MONARC-system which was implanted in the coronary sinus in the functional mitral regurgitation. A reduction in regurgitation by over 1 grade was documented in 50% of patients. MitraClip is an alternative, edge-to-edge technique, which joined the posterior and anterior leaflet by implanting a clip. It can be used for both functional and degenerativ mitral regurgitation. We reported a case of MitraClip procedure with the use of two clips and a reduction of mitral regurgitation to grade 0-1 after implanting a MONARC-device four years ago with missing relevant reduction in mitral regurgitation. With this report we illustrated the management of Mitraclip in a patient with implanted MONARC-device and technical difficulties through the bowing of the posterior anulus.

MitraClip procedure with two MitraClips after indirect annuloplasty with the MONARC device

Abstract Mitral regurgitation is associated with a worsened prognosis in dilated cardiomyopathy. First standard therapy consists of a mitral valve reconstruction through heart surgery including the heart–lung machine. In patients with high comorbidity, catheter-based techniques have been developed. In the Evolution I study, the MONARC system was implanted in the coronary sinus in the functional mitral regurgitation. A reduction in regurgitation by &gt;1 grade was documented in 50% of the patients. MitraClip is an alternative, edge-to-edge technique, which joined the posterior and anterior leaflet by implanting a clip. It can be used for both functional and degenerative mitral regurgitations. We reported a case of MitraClip procedure with the use of two clips and a reduction of mitral regurgitation to grade 0–1 after implanting a MONARC device four years ago with missing relevant reduction in mitral regurgitation. With this report, we illustrated the management of Mitraclip in a patient with an implanted MONARC device and technical difficulties through the bowing of the posterior annulus.

MitraClip in CRT non-responders with severe mitral regurgitation

BackgroundSevere mitral regurgitation (MR) ≥3+ and left ventricular dyssynchrony in heart failure patients are markers of CRT non response. The MitraClip (MC) implantation is a therapy for MR ≥3+ in patients with high surgical risk of mitral valve reconstruction. Methods and resultsWe investigated 42 patients with CRT and MR ≥3+ who received an MC device at our center. One and two year mortality rates were compared with the predicted mortality by Seattle Heart Failure Model (SHFM) and meta-analysis global group in chronic heart failure (MAGGIC), using the baseline characteristics of patients at the time of MC implantation.The median time interval between CRT and MC implantation was 20.1 (4.5–43.3) months. In 19 patients we observed a functional regurgitation with normal leaflets and in 23 patients a degenerative mechanism for mitral regurgitation. There was no change in mean QRS duration by biventricular pacing or MC implantation. The use of MC led to significant reductions in: median N-terminal pro-brain natriuretic peptide (NT-proBNP) level (pg/ml) from 3923 to 2636 (p=0.02), tricuspid regurgitation pressure gradient (TRPG) from 43 to 35mmHg (p=0.019) and in left ventricular end-diastolic volume (LVEDV) by MC (p=0.008). At the 2year follow-up interval the all-cause mortality was 25%. ConclusionMC implantation leads to an improvement of NT-proBNP level, TRPG and LVEDV in both functional and degenerative MR but does not influence QRS duration. Two year all-cause mortality was 25% and did not differ significantly from that predicted by SHFM and MAGGIC.

192 * CONTEMPORARY LONG-TERM OUTCOMES OF AN AGGRESSIVE APPROACH TO MITRAL VALVE REPAIR IN CHILDREN: IS IT EFFECTIVE AND DURABLE FOR BOTH CONGENITAL AND ACQUIRED MITRAL VALVE LESIONS?

Objectives: We analysed the long-term outcomes of mitral valve (MV) repair in children and compared the repairs for both congenital and acquired lesions. Methods: A review of 634 children (≤18 years) who underwent MV repair between 1992 and 2011 (excluding patients with complete atrioventricular septal defects, single ventricle and atrioventricular discordance). Mean age was 9.6 years (6 weeks to 18 years). Associated cardiac anomalies present in 473 patients (74.6%). Congenital mitral lesions were found in 270 (42.6%) patients compared to the acquired aetiology in 364 (57.4%) patients (mainly rheumatic; 329 patients, 90.4%). Mitral regurgitation (MR) was predominant in 606 (95.6%) patients and 544 (85.8%) of these showed ≥3+ MR. Modified techniques of MV reconstructions were used. Results: Early mortality was 2.2% (14 patients). Mean follow-up was 55.1 months (1–239.6 months; 84.7% complete). Late mortality was 3.6% (23 patients) and survival at 10 and 15 years was 91.2% and 85.8%, respectively. There was no significant difference in 10-year survival between repair of the congenital (97.9%) and acquired lesions (87.2%) (P = 0.177). Freedom from re-operation after MV repair for the entire population was 79.4% at 10 years [no significant difference (P = 0.171) between the congenital (80.3%) and acquired lesions (78.5%)]. Fifty-six patients (8.8%) had reoperation. Mixed MV lesions, commissural fusions and residual MR (≥2+) were the predictors of valve failure and reoperation. All survivors remain in NYHA class 1 and none had thromboembolism or pacemaker insertion. Conclusion: MV repair can be successfully applied to both congenital and acquired MV disease in children. Modifications of standard repair techniques and avoidance of residual MR have improved survival and durability.

Leakage test during mitral valve repair.

Mitral valve repair is the preferred surgical treatment for mitral regurgitation. Cardiac surgeons must increasingly pursue high-quality mitral valve repair, which ensures excellent long-term outcomes. Intraoperative assessment of a competency of the repaired mitral valve before closure of the atrium is an important step in accomplishing successful mitral valve repair. Saline test is the most simple and popular method to evaluate the repaired valve. In addition, an "Ink test" can provide confirmation of the surface of coaptation, which is often insufficient in the assessment of saline test. There are sometimes differences between the findings of the leakage test in an arrested heart and the echocardiographic findings after surgery. Assessment of the mitral valve in an arrested heart may not accurately reflect its function in a contractile heart. Assessment of the valve on the beating heart induced by antegrade or retrograde coronary artery perfusion can provide a more physiological assessment of the repaired valve. Perfusion techniques during beating heart surgery mainly include antegrade coronary artery perfusion without aortic cross-clamping, and retrograde coronary artery perfusion via the coronary sinus with aortic cross-clamping. It is the most important point for the former approach to avoid air embolism with such precaution as CO2 insufflation, left ventricular venting, and transesophageal echocardiography, and for the latter approach to maintain high perfusion flow rate of coronary sinus and adequate venting. Leakage test during mitral valve repair increasingly takes an important role in successful mitral valve reconstruction.

New engineering treatment of bovine pericardium confers outstanding resistance to calcification in mitral and pulmonary implantations in a juvenile sheep model

To conduct a test of noninferiority for CardioCel (Admedus, Brisbane, Australia), a chemically engineered bovine pericardium over autologous pericardium treated intraoperatively with glutaraldehyde in a chronic juvenile sheep model of pulmonary valve (PV) and mitral valve (MV) reconstruction. We replaced the posterior leaflet of the MV and of 1 PV cusp with patches in ewes aged 10 months. There were 2 groups: CardioCel (n = 6) and control (n = 4). All valves were competent. Echocardiography was performed before euthanasia. The collected data were function, macroscopy, histology, and calcium contents. The primary end points were thickening and calcium content. All animals survived until sacrifice after 7 months. The valves had normal echo. The macroscopic aspect of the valves was excellent. Examination of the slides for both groups revealed a continuous endothelium on both sides of the patch and a layer of new collagen developed on both sides between patch and endothelium and interstitial cells and smooth muscle cell in these layers. The patch had not thickened but the 2 layers of new collagen for the PV showed a median thickening of 37% in the CardioCel group and 111% in the control group (P = .01), and for the MV a thickening of 108% and 251%, respectively, was seen (P = .01). The median calcium content in the PV was 0.24 μg/mg (range, 0.19-0.30) in the CardioCel group versus 0.34 μg/mg (range, 0.24-0.62) in controls (P = .20). In the MV it was 0.46 μg/mg (range, 0.30-1.0) in the CardioCel group and 0.47 μg/mg (range, 0.29-1.9) in controls (P = 1.0). In this growing lamb model the CardioCel patch allowed accurate valve repair at both systemic and pulmonary pressure. The mechanical properties of CardioCel after 7 months were preserved with a more controlled healing than the treated autologous pericardium and without calcification.

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.

Republished: The evolving role of multimodality imaging in valvular heart disease

The public health burden of valvular heart disease (VHD) is projected to grow over the ensuing years owing to the persistent spectre of rheumatic heart disease in developing countries,w1 and...

3D echo mitral valve reconstruction - validity of a novel software application

3D echo mitral valve reconstruction - validity of a novel software application