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Aortic Valve Repair via Neo-Chordae Technique: Mechanistic Insight Through Numerical Modelling

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Abstract

Recently, the neo-chordae technique (NCT) was proposed to stabilize the surgical correction of isolated aortic valve (AV) prolapse. Neo-chordae are inserted into the corrected leaflet to drive its closure by minimal tensions and prevent relapses. In a previous in vitro study we analysed the NCT effects on healthy aortic roots (ARs). Here we extend that analysis via finite element models (FEMs). After successfully replicating the experimental conditions for validation purposes, we modified our AR FEM, obtaining a continent AV with minor isolated prolapse, thus representing a realistic clinical scenario. We then simulated the NCT, and systematically assessed the acute effects of changing neo-chordae length, opening angle, asymmetry and insertion on the aorta. In the baseline configuration the NCT restored physiological AV dynamics and coaptation, without inducing abnormal leaflet stresses. This outcome was notably sensitive only to neo-chordae length, suggesting that the NCT is a potentially easy-to-standardize technique. However, this parameter is crucial: major shortenings (6 mm) prevent coaptation and increase leaflet stresses by 359 kPa, beyond the yield limit. Minor shortenings (2–4 mm) only induce a negligible stress increase and mild leaflet tethering, which however may hamper the long-term surgical outcome.

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Acknowledgments

This study was funded by the “Fondazione per la Ricerca in Cardiochirurgia ONLUS”, Milan, Italy, and was supported by Regione Lombardia and CILEA Consortium through the 2010 grant of the LISA Initiative (Laboratory for Interdisciplinary Advanced Simulation) (http://lisa.cilea.it).

Conflict of Interest

The authors declare that no financial and personal relationships apply with other people or organisations that could inappropriately influence this work.

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Authors and Affiliations

  1. Department of Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy

    Emiliano Votta, Luca Paroni, Carlo A. Conti, Alessandra Pelosi, Paolo D’Alesio, Riccardo Vismara & Alberto Redaelli

  2. FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy

    Emiliano Votta, Luca Paroni, Andrea Mangini, Paolo D’Alesio, Riccardo Vismara, Carlo Antona & Alberto Redaelli

  3. Cardiac Surgery Unit, H.L. Sacco, Università di Milano, Milan, Italy

    Andrea Mangini & Carlo Antona

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  1. Emiliano Votta
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  2. Luca Paroni
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  3. Carlo A. Conti
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  4. Alessandra Pelosi
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  7. Riccardo Vismara
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  8. Carlo Antona
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  9. Alberto Redaelli
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Correspondence to Riccardo Vismara.

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Associate Editor Peter E. McHugh oversaw the review of this article.

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Votta, E., Paroni, L., Conti, C.A. et al. Aortic Valve Repair via Neo-Chordae Technique: Mechanistic Insight Through Numerical Modelling. Ann Biomed Eng 40, 1039–1051 (2012). https://doi.org/10.1007/s10439-011-0497-9

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  • DOI: https://doi.org/10.1007/s10439-011-0497-9

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