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September 14, 2026Circulation Cardiovascular Interventions

Aberrant, Elevated Papillary Muscle and LV Wall Forces Associated With Mitral Valve Prolapse Are Normalized by Surgical Neochordal Repair but Not by Transcatheter Edge-to-Edge Repair

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Why the study?

Mitral valve prolapse has been linked to increased papillary muscle traction, prompting an ex vivo biomechanical comparison of edge-to-edge repair via MitraClip versus neochordal repair on papillary muscle forces.

Does neochordal repair compared to edge-to-edge repair normalize papillary muscle forces in an ex vivo model of mitral valve prolapse?

Population

8 porcine mitral valves in a left heart simulator

Comparison

Control, prolapse, chordal rupture, MitraClip, surgical edge-to-edge repair, and neochordal repair

Design

Ex vivo randomized, paired biomechanical study

Key result

In an ex vivo porcine model, MitraClip repair increased peak papillary muscle forces by ~23% versus baseline, whereas neochordal repair restored forces to near-baseline levels (6.8±1.3 N; P=0.53).

Authors

MPMatthew H. ParkAKAntonia van KampenCHChris Huynh

Discussion

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Member takes

Overview

Neochordal repair may normalize papillary muscle forces better than MitraClip in prolapse models; leaves open translation to human durability and outcomes.

Key Points

  • To biomechanically compare the effects of transcatheter edge-to-edge repair and surgical neochordal repair on papillary muscle forces in mitral valve prolapse.
  • Mounted porcine mitral valves (n=8) in a left heart simulator equipped with a force transduction system to track papillary muscle forces during the cardiac cycle.
  • Conducted randomized, paired biomechanical assessments across baseline control, chordal rupture prolapse, MitraClip repair, surgical edge-to-edge repair, and neochordal repair states.
  • Chordal rupture induced pathological regurgitation (23.7±18.5% vs. 3.1±1.0% in controls; P<0.001) and elevated composite peak papillary muscle forces to 7.8±1.3 N (~16% over baseline 6.7±0.7 N; P=0.005).
  • Both surgical and MitraClip edge-to-edge repair increased peak papillary muscle forces compared to baseline (P<0.001) and prolapse conditions (P=0.03), with MitraClip forces ~23% higher than baseline.
  • Neochordal repair reduced peak papillary muscle forces back to near-baseline levels (6.8±1.3 N; P=0.53 vs. baseline), while all repair interventions reduced mitral regurgitation to <15%.

Structured PICO

Does neochordal repair compared to edge-to-edge repair normalize papillary muscle forces in an ex vivo model of mitral valve prolapse?

P
Population
8 porcine mitral valves evaluated in an ex vivo left heart simulator to compare biomechanical forces after MitraClip versus neochordal repair.
I
Intervention
Transcatheter edge-to-edge repair (MitraClip), surgical edge-to-edge repair, and neochordal repair
C
Comparator
Baseline control valves, prolapse condition, and chordal rupture condition
O
Outcome
Forces exerted on the papillary muscles (PM forces) and mitral regurgitation levelssurrogate

Main Result

Absolute Event Rate: 6.8% vs 6.7%

p-value: p=0.53

In an ex vivo model, neochordal repair normalizes papillary muscle forces associated with mitral valve prolapse, whereas edge-to-edge repair increases these aberrant forces despite reducing regurgitation.

Cite This Study

Park et al. (2026) studied mitral valve prolapse (n=8). MitraClip edge-to-edge repair and neochordal repair vs. baseline control, prolapse, and chordal rupture conditions was evaluated on peak papillary muscle forces (p=0.53). In an ex vivo porcine model, MitraClip repair increased peak papillary muscle forces by ~23% versus baseline, whereas neochordal repair restored forces to near-baseline levels (6.8±1.3 N; P=0.53).

synapsesocial.com/papers/6aa7b2c70926e14a848b152chttps://doi.org/10.1161/circinterventions.125.016161
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