Mechanical and Geometric Characterization of a Novel 2-Ply Vacuum-Pressed Biological Scaffold Patch Design for Posterior Mitral Valve Reconstruction

Figures

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  Fig. 1. Dimensions of the SIS-ECM samples according to the American Society for Testing and Material tensile test standard

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  Fig. 2. Geometrical measurements based on magnetic resonance imaging scans in a long-axis view of the heart in diastole and b short-axis view of the heart in diastole of five healthy, female 80-kg pigs used to propose the posterior mitral valve patch design. AP: annular plane; APMA: anterolateral papillary muscle to annulus length; APMP2: anterolateral papillary muscle to P2 length; P1, P2, and P3: posterior mitral valve scallops; PPMA: posteromedial papillary muscle to annulus length; PPMP2: posteromedial papillary muscle to P2 length

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  Fig. 3. Schematic drawing of the in vitro left heart simulator

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  Fig. 4. Schematic drawings of the posterior mitral valve patch design and implantation technique. a The specific dimensions of the patch design. b The measured A1, A2, A3 and P1, P2, P3 segments seen from a superior view. The big dots represent the coaptation point. c The native mitral valve implanted in the in vitro model. d The reconstruction, illustrating the 3-suture loop technique used to attach the four anchoring points of the patch to their respective papillary muscle heads, placed approximately 1 cm apart on each papillary muscle. e The patch being implanted in the in vitro model. f The patch implanted in the in vitro model. The red arrows indicate the applied ventricular pressure closing the reconstructed valve during systole

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  Fig. 5. Stress vs strain graphs depicting the typical load response for each of the four different SIS-ECM samples. a Typical load response of the 2-ply lyophilized SIS-ECM. b Typical load response of the vacuum-pressed SIS-ECM. c Typical load response of the 4-ply lyophilized SIS-ECM. d Typical load response of the 4-ply vacuum-pressed SIS-ECM

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  Fig. 6. Representative images of closed valves seen from an atrial point of view comparing native a and reconstructed b mitral valves implanted in the in vitro model with annulus, coaptation lines and leaflet scallops