Dynamic Patient-Specific Three-Dimensional Simulation of Mitral Repair

Ginty, Olivia K.; Moore, John; Xu, Yuanwei; Xia, Wenyao; Fujii, Satoru; Bainbridge, Daniel; Peters, Terry M.; Kiaii, Bob; Chu, Michael

doi:10.1177/155698451801300103

Cited by 6 publications

(10 citation statements)

References 24 publications

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“…Overall, the model measurements were accurate when compared to the patients. Mitral valve repair was successful in all 10 of the models and the repair was comparable to the actual mitral valve repair the patient received [30].…”

Section: Use Of Simulatorsmentioning

confidence: 76%

“…Ginty et al [30] used preoperative echocardiography to segment, model, and 3D print patient-specific mitral valve models, including the subvalvular apparatus. They assessed the accuracy of their 10 different patient mitral valve models in a phantom simulator, and subsequently compared them to the results of the actual patient operations.…”

Section: Use Of Simulatorsmentioning

confidence: 99%

“…The 3D printed models were assessed objectively by blinded echocardiography and subjectively by two mitral valve repair experts. A simulated mitral valve repair was performed on the 3D mitral valve models, and the simulated outcomes were compared with actual patient outcomes with echocardiography [30]. Overall, the model measurements were accurate when compared to the patients.…”

Section: Use Of Simulatorsmentioning

confidence: 99%

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Simulating mitral repair: lessons learned

White,

Zarzycki,

Bisleri

2024

Current Opinion in Cardiology

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Purpose of review With the growing complexity of cardiac surgical cases, increased focus on patient safety, and minimally invasive techniques, simulation-based training has experienced a renaissance. This review highlights important elements of simulation-based training, focusing specifically on available simulators for mitral valve repair and the uses for simulation. Recent findings Referring to simulators as being high or low fidelity is oversimplified. Fidelity is a multifactorial concept, and for surgical task trainers, structural and functional fidelity should be discussed. For mitral valve repair, there are a spectrum of simulators, including tissue-based models, bench-top models, and hybrid models. All these simulator modalities serve a role in training if they align with predetermined objectives. There have been advancements in mitral valve repair simulation, notably patient-specific 3D printed silicone replicas of disease. Summary There is evidence to support that simulation improves performance in the simulated environment, but future investigation should look to determine whether simulation improves performance in the clinical setting and ultimately patient outcomes.

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Section: Use Of Simulatorsmentioning

confidence: 76%

Section: Use Of Simulatorsmentioning

confidence: 99%

Section: Use Of Simulatorsmentioning

confidence: 99%

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Simulating mitral repair: lessons learned

White,

Zarzycki,

Bisleri

2024

Current Opinion in Cardiology

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“…Prior work on heart simulator technology has been focused on its use for procedure planning, where a replica of a patient's valve is created from diagnostic imaging so that a repair can be simulated and evaluated pre-operatively. 9 There is potential for the use of simulators for surgical training to address the current gap in clinical practice from seeing a procedure being performed, to doing one. To effectively incorporate heart simulators into surgical training, it is necessary to produce a variety of valve models with a range of pathologies.…”

Section: Applications To Surgical Trainingmentioning

confidence: 99%

“…5,6 Originally developed as an alternative to the use of live animal (porcine) models of the left ventricle and mitral/aortic valves for testing new interventional procedures, heart simulator technology has been adopted widely by both industry for the evaluation of technologies for imaging heart valves, 7 and academia for the assessment of modelled heart valves. 8 While dynamic patient-specific valve replicas created from patient transesophageal echocardiography (TEE) images have proven useful in surgical planning for specific cases, 9 their ability to mimic actual MV tissue geometry is limited by the spatial and temporal resolution of the TEE images on which they are based. This is most evident in regions where non-contiguous tissue (for example, coaptation regions where distinct leaflet cusps meet) is modelled as a single, continuous band of tissue.…”

Section: Introductionmentioning

confidence: 99%

Physical replication and validation of mathematical mitral valve models

Carnahan,

Yuan,

Moore

et al. 2024

Medical Imaging 2024: Image-Guided Procedures, Robotic Interventions, and Modeling

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Accurate models of the mitral valve are highly valuable for studying the physiology of the heart and its various pathologies, as well as creating physical replicas for cardiac surgery training. Currently, heart simulator technologies are used which rely on patient-specific data to create valve r eplicas. Alternatively, mathematical models of the mitral valve have been developed for computational applications. However, there are no studies that mathematically model both the mitral valve's leaflets and its saddle-shaped annulus in a single design together in current l iterature. This results in anatomic inaccuracies in current models, as either only the leaflets or the saddle-shaped annulus are realistically m odelled. Mathematical models to date have not been replicated as dynamic, physical valves and validated in a heart simulator system. We propose a new parametric representation of the mitral valve based on a combination of valve models from prior literature, combining both accurate leaflet shape, and annular geometry. A physical silicone replica of the model is created and validated in a pulse duplicator. Using a transesophageal echocardiography probe with color Doppler imaging, we demonstrate that our combined model replicates healthy valve behaviour, showing no regurgitation at realistic pressure gradients across the valve.

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An ex-vivo and in-vitro dynamic simulator for surgical and transcatheter mitral valve interventions

Karl,

Romano,

Marx

et al. 2023

Int J CARS

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Purpose Minimally invasive mitral valve surgery (MIMVS) and transcatheter edge-to-edge repair (TEER) are complex procedures used to treat mitral valve (MV) pathologies, but with limited training opportunities available. To enable training, a realistic hemodynamic environment is needed. In this work we aimed to develop and validate a simulator that enables investigation of MV pathologies and their repair by MIMVS and TEER in a hemodynamic setting. Methods Different MVs were installed in the simulator, and pressure, flow, and transesophageal echocardiographic measurements were obtained. To confirm the simulator’s physiological range, we first installed a biological prosthetic, a mechanical prosthetic, and a competent excised porcine MV. Subsequently, we inserted two porcine MVs—one with induced chordae tendineae rupture and the other with a dilated annulus, along with a patient-specific silicone valve extracted from echocardiography with bi-leaflet prolapse. Finally, TEER and MIMVS procedures were conducted by experts to repair the MVs. Results Systolic pressures, cardiac outputs, and regurgitations volumes (RVol) with competent MVs were 119 ± 1 mmHg, 4.78 ± 0.16 l min−1, and 5 ± 3 ml respectively, and thus within the physiological range. In contrast, the pathological MVs displayed increased RVols. MIMVS and TEER resulted in a decrease in RVols and mitigated the severity of mitral regurgitation. Conclusion Ex-vivo modelling of MV pathologies and repair procedures using the described simulator realistically replicated physiological in-vivo conditions. Furthermore, we showed the feasibility of performing MIMVS and TEER at the simulator, also at patient-specific level, thus providing new clinical perspectives in terms of training modalities and personalized planning.

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Dynamic Patient-Specific Three-Dimensional Simulation of Mitral Repair

Cited by 6 publications

References 24 publications

Simulating mitral repair: lessons learned

Simulating mitral repair: lessons learned

Physical replication and validation of mathematical mitral valve models

An ex-vivo and in-vitro dynamic simulator for surgical and transcatheter mitral valve interventions

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