Biomechanical engineering comparison of four leaflet repair techniques for mitral regurgitation using a novel 3-dimensional–printed left heart simulator

Figures

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  Biomechanical comparison of various mitral valve repair techniques.

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  Figure 1. A, Schematic of the Stanford left heart simulator in the mitral testing configuration with each component labeled. B, Close-up view of FBG force sensor attached to a chordae tendinea of interest. PL, Posterior leaflet; AL, anterior leaflet; TEE, transesophageal echo; APM, anterolateral papillary muscle; FBG, fiber Bragg Gratings; PPM, posteromedial papillary muscle.

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  Video 1. En face view of high speed videometric footage highlighting each repair technique. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00671-4/fulltext.

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  Figure 2. En face view of each valve at baseline, after induction of prolapse, and after each repair technique during mid-systole demonstrating leaflet coaptation differences among each technique.

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  Figure 3. A, Regurgitant fraction is significantly higher in the edge-to-edge (E) group relative to the other repair techniques when normalized to baseline values (P < .01 for each). B, Primary chordae forces relative to baseline are significantly higher in the edge-to-edge technique versus the neochord technique (P = .002). The resection technique also results in higher primary chordae forces when compared with the neochord (P = .001) and nonrsectional remodeling (P = .04) techniques. C, Secondary chordae forces relative to baseline forces were significantly elevated after edge-to-edge repair versus neochord repair (P = .03) and nonresectional remodeling techniques (P = .02), whereas the other repair techniques resulted in similar secondary chordae forces compared with baseline levels. NC, Neochord; NR, nonresectional remodeling; R, resection. The P values refer to post hoc comparisons with Bonferroni correction from the mixed model.