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Pre-clinical Experience with a Multi-Chordal Patch for Mitral Valve Repair

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Abstract

Surgical repair of flail mitral valve leaflets with neochordoplasty has good outcomes, but implementing it in anterior and bi-leaflet leaflet repair is challenging. Placing and sizing individual neochordae is time consuming and error prone, with persistent localized flail if performed incorrectly. In this study, we report our pre-clinical experience with a novel multi-chordal patch for mitral valve repair. The device was designed based on human cadaver hearts, and laser cut from expanded polytetrafluoroethylene. The prototypes were tested in: (stage 1) ex vivo hearts with leaflet flail (N = 6), (stage 2) acute swine induced with flail (N = 6), and (stage 3) two chronic swine survived to 23 and 120 days (N = 2). A2 and P2 prolapse were successfully repaired with coaptation length restored to 8.1 ± 2.2mm after posterior repair and to 10.2 ± 1.3mm after anterior repair in ex vivo hearts. In vivo, trace regurgitation was seen after repair with excellent patch durability, healing, and endothelialization at euthanasia. A new device for easier mitral repair is reported, with good early pre-clinical outcomes.

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Author Contributions

S.K.C. and M.P. conceived the study, designed the experiments, conducted the study, interpreted the results, and wrote the manuscript. W.W.S., B.M., and J.V.J. were part of the surgical team. R.W.M.F. provided valuable feedback through the entire study. M.P. handled manuscript submission, revisions to the manuscript, and response to reviewers. Authors thank Ms. Deepal Panchal and Ms. Susan Schmarkey for their contributions.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Saint Francis Hospital and Medical Center, Hartford, CT, USA

    Surendra K. Chawla

  2. Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Division of Cardiothoracic Surgery, Emory University, 380-B, Northyards Blvd, Atlanta, GA, 30313, USA

    Weiwei Shi, Bryant V. McIver, Jakob Vinten-Johansen & Muralidhar Padala

  3. Division of Cardiothoracic Surgery, Albert Einstein School of Medicine, New York, NY, USA

    Robert W. M. Frater

Authors
  1. Surendra K. Chawla
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  2. Weiwei Shi
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  3. Bryant V. McIver
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  4. Jakob Vinten-Johansen
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  5. Robert W. M. Frater
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  6. Muralidhar Padala
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Corresponding author

Correspondence to Muralidhar Padala.

Ethics declarations

The Institutional Animal Care and Use Committee at Emory University/T3 labs approved the studies, and the procedures were performed according to the PHS policies on humane care and use of laboratory animals.

Funding

This work was partially funded by the American Heart Association via grant 14SDG20380081, and a research grant from the Carlyle Fraser Heart Center to M.P.

Conflict of Interest

S.K.C. holds a patent on this technology. Rest of the authors does not have any conflicts of interest.

Additional information

Associate Editor Craig Stolen oversaw the review of this article

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Chawla, S.K., Shi, W., McIver, B.V. et al. Pre-clinical Experience with a Multi-Chordal Patch for Mitral Valve Repair. J. of Cardiovasc. Trans. Res. 9, 127–134 (2016). https://doi.org/10.1007/s12265-016-9674-4

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  • DOI: https://doi.org/10.1007/s12265-016-9674-4

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