Transcatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation

Mitral regurgitation (MR) is the most prevalent valvulopathy in the USA and the second most prevalent valvulopathy in Europe. Despite excellent clinical results of surgical mitral valve repair (SMVR), transcatheter-based mitral valve repair (MVR) procedures emerged as a feasible treatment option for...

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Autores principales:	Ott Robert, Kaule Sebastian, Großmann Swen, Stiehm Michael, Schmitz Klaus-Peter, Siewert Stefan, Öner Alper Ö, Ince Hüseyin, Grabow Niels
Formato:	article
Lenguaje:	EN
Publicado:	De Gruyter 2020
Materias:	mitral regurgitation mitral valve repair mitraclip-system pascal-system in vitro model Medicine R
Acceso en línea:	https://doaj.org/article/b63a93697e1a42cb8d11984e1ac8550f
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spelling	oai:doaj.org-article:b63a93697e1a42cb8d11984e1ac8550f2021-12-05T14:10:42ZTranscatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation2364-550410.1515/cdbme-2020-3055https://doaj.org/article/b63a93697e1a42cb8d11984e1ac8550f2020-09-01T00:00:00Zhttps://doi.org/10.1515/cdbme-2020-3055https://doaj.org/toc/2364-5504Mitral regurgitation (MR) is the most prevalent valvulopathy in the USA and the second most prevalent valvulopathy in Europe. Despite excellent clinical results of surgical mitral valve repair (SMVR), transcatheter-based mitral valve repair (MVR) procedures emerged as a feasible treatment option for surgically inoperable or high-risk patients suffering from clinically relevant MR. The current study investigates the impact of device-induced coaptationwidth on the hydrodynamic performance of insufficient mitral valves (MV) during left ventricular (LV) systole. A non-calcified, pathological MV model (MVM) featuring a D-shaped MV annulus with an area of 7.6 cm2 and a flail gap in the A2-P2 region was employed in an experimental setup. Pressure gradient-volumetric flow rate (Δp-Q) relations were investigated for steady-state backward flow with transvalvular pressure gradients ranging from (0.75 ≤ Δp ≤ 177.36) mmHg. Glycerol-water mixture (36 % (v/v) glycerol in water) at 37 °C with a density of (1 098.2 ± 1.3) kg·m-3 and a dynamic viscosity of 3.5 mPa∙s was used as circulatory fluid. In order to determine the impact of the width of transcatheter MVR devices during LV-systole Δp-Q relations were investigated for three MVM-configurations: (i) MVM without MVR device, (ii) MVM with one MVR device and (iii) MVM with two MVR devices implanted in the A2-P2 region. The MVR devices were manufactured from steel sheets with a thickness of 0.2 mm and feature arm lengths of 9.0 mm and a width of 5.0 mm. The conducted investigations show that the implantation of MVR devices in the A2-P2 region prevents the manifestation of an A2-P2 flail gap and thereby effectively reduces the retrograde blood flow during the LV-systole by 13 % with one MVR device and 27 % with two MVR devices implanted. Thus, the application of two MVR devices with a combined device-induced width of 10 mm results in a better MR reduction than the implantation of one MVR device with a device-induced width of 5 mm.Ott RobertKaule SebastianGroßmann SwenStiehm MichaelSchmitz Klaus-PeterSiewert StefanÖner Alper ÖInce HüseyinGrabow NielsDe Gruyterarticlemitral regurgitationmitral valve repairmitraclip-systempascal-systemin vitro modelMedicineRENCurrent Directions in Biomedical Engineering, Vol 6, Iss 3, Pp 217-220 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	mitral regurgitation mitral valve repair mitraclip-system pascal-system in vitro model Medicine R
spellingShingle	mitral regurgitation mitral valve repair mitraclip-system pascal-system in vitro model Medicine R Ott Robert Kaule Sebastian Großmann Swen Stiehm Michael Schmitz Klaus-Peter Siewert Stefan Öner Alper Ö Ince Hüseyin Grabow Niels Transcatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation
description	Mitral regurgitation (MR) is the most prevalent valvulopathy in the USA and the second most prevalent valvulopathy in Europe. Despite excellent clinical results of surgical mitral valve repair (SMVR), transcatheter-based mitral valve repair (MVR) procedures emerged as a feasible treatment option for surgically inoperable or high-risk patients suffering from clinically relevant MR. The current study investigates the impact of device-induced coaptationwidth on the hydrodynamic performance of insufficient mitral valves (MV) during left ventricular (LV) systole. A non-calcified, pathological MV model (MVM) featuring a D-shaped MV annulus with an area of 7.6 cm2 and a flail gap in the A2-P2 region was employed in an experimental setup. Pressure gradient-volumetric flow rate (Δp-Q) relations were investigated for steady-state backward flow with transvalvular pressure gradients ranging from (0.75 ≤ Δp ≤ 177.36) mmHg. Glycerol-water mixture (36 % (v/v) glycerol in water) at 37 °C with a density of (1 098.2 ± 1.3) kg·m-3 and a dynamic viscosity of 3.5 mPa∙s was used as circulatory fluid. In order to determine the impact of the width of transcatheter MVR devices during LV-systole Δp-Q relations were investigated for three MVM-configurations: (i) MVM without MVR device, (ii) MVM with one MVR device and (iii) MVM with two MVR devices implanted in the A2-P2 region. The MVR devices were manufactured from steel sheets with a thickness of 0.2 mm and feature arm lengths of 9.0 mm and a width of 5.0 mm. The conducted investigations show that the implantation of MVR devices in the A2-P2 region prevents the manifestation of an A2-P2 flail gap and thereby effectively reduces the retrograde blood flow during the LV-systole by 13 % with one MVR device and 27 % with two MVR devices implanted. Thus, the application of two MVR devices with a combined device-induced width of 10 mm results in a better MR reduction than the implantation of one MVR device with a device-induced width of 5 mm.
format	article
author	Ott Robert Kaule Sebastian Großmann Swen Stiehm Michael Schmitz Klaus-Peter Siewert Stefan Öner Alper Ö Ince Hüseyin Grabow Niels
author_facet	Ott Robert Kaule Sebastian Großmann Swen Stiehm Michael Schmitz Klaus-Peter Siewert Stefan Öner Alper Ö Ince Hüseyin Grabow Niels
author_sort	Ott Robert
title	Transcatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation
title_short	Transcatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation
title_full	Transcatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation
title_fullStr	Transcatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation
title_full_unstemmed	Transcatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation
title_sort	transcatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation
publisher	De Gruyter
publishDate	2020
url	https://doaj.org/article/b63a93697e1a42cb8d11984e1ac8550f
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Transcatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation

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