Di Micco, L;
Peruzzo, P;
Colli, A;
Burriesci, G;
Boso, D;
Besola, L;
Gerosa, G;
(2019)
The Neochord Mitral Valve Repair Procedure: Numerical Simulation of Different Neochords Tensioning Protocols.
Medical Engineering & Physics
, 74
pp. 121-128.
10.1016/j.medengphy.2019.09.014.
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Abstract
Transapical off-pump mitral valve repair with neochord implantation is an established technique for minimally-invasive intervention on mitral valve prolapse/flail. The procedure involves the positioning of artificial chords, whose length/tension is adjusted intraoperatively, adopting different methods based on the experience of the surgeon. This unsystematic approach occasionally leads to complications such as leaflet rupture and excessive/insufficient load on the neochords. In this study, finite element models of a generalized prolapsing mitral valve are used to verify the effect of two alternative tensioning approaches (AT – All together and 1by1 – one by one sequences) on the coaptation area and valve biomechanics, comparing results with a corresponding healthy configuration. The total force of about 1 N is exerted by the chords in both strategies, but the maximum stress and coaptation area are closer to those of the healthy configuration in the 1by1 sequence. However, the analysis also provides an explanation for the chords unloading in the 1by1 strategy observed in the clinical practice, and suggests an optimum tensioning methodology for NeoChord procedures. The study also reveals the potential power of the implemented numerical approach to serve as a tool for procedural planning, supporting the identification of the most suitable ventricular access site and the most effective stitching points for the artificial chords.
| Type: | Article |
|---|---|
| Title: | The Neochord Mitral Valve Repair Procedure: Numerical Simulation of Different Neochords Tensioning Protocols |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.medengphy.2019.09.014 |
| Publisher version: | https://doi.org/10.1016/j.medengphy.2019.09.014 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | NeoChord procedure, Mitral Valve Repair, Finite Elements Analysis, Tensioning Strategies, Mitral Valve Prolapse |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10081822 |
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