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Implantation of personalized, biocompatible mitral annuloplasty rings: feasibility study in an animal model

Simon H Sündermann, Michael Gessat, Nikola Cesarovic, Thomas Frauenfelder, Patric Biaggi, Dominique Bettex, Volkmar Falk, and Stephan Jacobs
Interactive Cardiovascular and Thoracic Surgery
Vol. 16, No. 4, pp. 417-24, April 2013

Abstract

Abstract OBJECTIVES Implantation of an annuloplasty ring is an essential component of a durable mitral valve repair. Currently available off-the-shelf rings still do not cover all the variations in mitral annulus anatomy and pathology from subject to subject. Computed tomography (CT) and echo imaging allow for 3-D segmentation of the mitral valve and mitral annulus. The concept of tailored annuloplasty rings has been proposed although, to date, no surgically applicable implementation of patient-specific annuloplasty rings has been seen. The objective of this trial was to prove the concept of surgical implantation of a model-guided, personalized mitral annuloplasty ring, manufactured based on individual CT-scan models. METHODS ECG-gated CT angiography was performed in six healthy pigs under general anaesthesia. Based on the individual shape of the mitral annulus in systole, a customized solid ring with integrated suturing holes was designed and manufactured from a biocompatible titanium alloy by a rapid process using laser melting. The ring was implanted three days later and valve function was assessed by intraoperative echocardiography. The macroscopic annulus–annuloplasty match was assessed after heart explantation. RESULTS CT angiography provided good enough image quality in all animals to allow for segmentation of the mitral annulus. The individually tailored mitral rings were manufactured and successfully implanted in all pigs. In 50%, a perfect matching of the implanted ring and the mitral annulus was achieved. In one animal, a slight deviation of the ring shape from the circumference was seen postoperatively. The rings implanted in the first two animals were significantly oversized but the deviation did not affect valve competence. CONCLUSIONS CT image quality and accuracy of the dimensions of the mitral annulus were sufficient for digital modelling and rapid manufacturing of mitral rings. Implantation of individually tailored annuloplasty rings is feasible.


Link to publisher's page
@Article{eth_biwi_01012,
  author = {Simon H S\"undermann and Michael Gessat and Nikola Cesarovic and Thomas Frauenfelder and Patric Biaggi and Dominique Bettex and Volkmar Falk and and Stephan Jacobs},
  title = {Implantation of personalized, biocompatible mitral annuloplasty rings: feasibility study in an animal model},
  journal = {Interactive Cardiovascular and Thoracic Surgery},
  year = {2013},
  month = {April},
  pages = {417-24},
  volume = {16},
  number = {4},
  keywords = {}
}