phosphorus-31-magnetic-resonance-spectroscopy-for-serial-measurements

Phosphorus-31 Magnetic Resonance Spectroscopy for Serial Measurements of Cardiac Energetics During Temperature-Controlled Heart Preservation

Reliable organ preservation is critical to increasing donor availability and improving transplant outcomes. While static storage remains the standard for ...

Johns Hopkins University School of Medicine

Optimal translocation patch width for functional mitral regurgitation (FMR) treatment was evaluated in an air-filled ex vivo system. FMR was created in 19 isolated swine hearts by annular dilation and papillary muscle displacement. Frustum-shaped pericardial patches of varying widths (Group 1 = 0.5 cm; Group 2 = 1.0 cm; Group 3 = 1.5 cm) were implanted and imaged via a 3D-structured light scanner. Median leaflet coaptation decreased (P < 0.001) from 5.5 ± 2.0 mm at baseline to 2.4 ± 1.3 mm following FMR creation. Translocation repair increased coaptation length over FMR levels by 2.2 mm in Group 1 (P < 0.001), 4.6 mm in Group 2 (P < 0.001), and 4.7 mm in Group 3 (P < 0.001). After repair, no significant differences were found between groups for annular height, circularity index, tenting height, tenting area, and non-coapting surface area. The supranormal coaptation and minimal valve geometric changes support using a 1.0- or 1.5-cm translocation patch for FMR treatment. Implantation of a 1.0-cm or 1.5-cm circumferential pericardial patch (mitral valve translocation) increases leaflet coaptation length without significantly altering valve geometry.

Mitral Valve Translocation: Optimization of Patch Geometry in an Ex Vivo Model of Secondary Mitral Regurgitation.

Standardization of Mitral Regurgitation Grading Starts with Abandoning Historical "Plus" Terminology.

Current repair options for functional mitral regurgitation (FMR) are not durable and do not adequately address underlying pathophysiology including leaflet tethering and insufficient coaptation. The feasibility of mitral valve translocation as a repair strategy for FMR was examined in normal swine. Seven pigs (median 62 kg, IQR 55-65 kg) with normal cardiac function were implanted with a 1-cm frustum-shaped pericardial patch inserted between the native mitral annulus and intact mitral leaflets. Operative survival was 100% with no post-procedure mitral stenosis, systolic anterior motion, or central mitral regurgitation observed on echocardiography. Post-translocation mean gradient was 3.5 mmHg (IQR 1.5-4 mmHg); trace or mild suture line leaks on the atrial suture line were noted in 5/7 pigs. Median leaflet coaptation increased from 2.4 (IQR 2.1-4.3 mm) to 12.4 mm (IQR 10.8-13.4 mm) after translocation (P = 0.016). Translocation dramatically increases leaflet coaptation without impairing diastolic function in animals with normal left ventricular function and is a promising technique for repair of FMR. Implantation of a 1.0-cm circumferential pericardial patch (mitral valve translocation) increases leaflet coaptation in a normal animal model.

Translocation of the Mitral Valve in an Acute Large Animal Model.

Adding Mitral Valve Translocation to the Tool Kit for Treatment of Secondary Mitral Regurgitation.

The COVID-19 pandemic necessitated a drastic increase in the use of telemedicine. There is little information about the effectiveness of telemedicine in cardiac surgery. We examined clinical outcomes and patient satisfaction among patients who had in-person versus telemedicine preoperative appointments in a subspecialized mitral valve surgical practice.

Effectiveness of telemedicine in a mitral valve center of excellence.

Mitral valve translocation (MVT) is a novel procedure that was developed to treat patients with severe, symptomatic, secondary mitral regurgitation (MR). MVT enhances leaflet coaptation by insertion of an autologous pericardial patch interposed between the mitral annulus and the native mitral leaflets. The patch substantially increases total leaflet surface area and creates supranormal coaptation. In addition, it relieves leaflet tethering by transposing the native valve deeper into the ventricle and decreases the circumference of the annulus. The enhanced coaptation produced by MVT may protect against recurrent MR in patients with continued adverse left ventricular remodeling. The procedural steps include detachment of the intact native mitral valve at the annulus, placement of interrupted pledgeted sutures around the annulus to secure the proximal aspect of the patch, and attachment of the native valve to the distal aspect of the patch using running suture. Follow-up of patients who have undergoing MVT is ongoing, with satisfactory short-term results, including sustained MR grades of ≤mild and 14 mm coaptation at 12 months.

How To Do It: Mitral Valve Translocation.

Mitral Valve Translocation: A Novel Approach to Repair Secondary Mitral Regurgitation.

The redundant leaflet tissue and annular pathology of Barlow disease can make surgical repair challenging. We examined perioperative and late outcomes of a large cohort of patients with Barlow disease undergoing surgical repair.

Non-resectional cordal repair for Barlow mitral valve disease.

Conduction abnormalities requiring permanent pacemaker (PPM) implantation are common after tricuspid valve operations, although the incidence is variable. This study investigated contemporary rates of and risk factors for a PPM after tricuspid operations.

Factors Associated With Permanent Pacemaker Placement After Tricuspid Valve Operations.

Annuloplasty is the most common strategy for repair of functional tricuspid regurgitation (FTR) but is not effective in patients with massive/torrential FTR or leaflet tethering. To address the deficits of tricuspid annuloplasty, TRicuspid Anterior and Posterior Patch (TRAPP) repair was developed, which is a pericardial patch augmentation of the anterior and posterior leaflets.

Tricuspid Anterior and Posterior Patch (TRAPP) Repair of Functional Tricuspid Regurgitation.

Tricuspid anteroposterior patch (TRAPP) repair aims to address shortcomings of traditional annuloplasty in functional tricuspid regurgitation by selectively enlarging and translocating the anterior and posterior leaflets, but optimal patch width has not been identified.

Tricuspid Anteroposterior Patch Repair: Optimization of Patch Geometry in an Ex Vivo Model.

A 4-h preservation time threshold for cardiac allografts is the current standard in heart transplantation, but novel technologies are proposed to decrease the morbidity associated with prolonged allograft storage. This study examined adult heart transplant recipients from 2000-2015 and 2020-2023 in the United States, stratified into an early (2000-2015) and modern era (2020-2023), then into standard (≤ 4 h) and prolonged (≥ 5 h) preservation time groups within each era. This study reinforced the 4-h threshold in the early era, where prolonged preservation significantly increased one-year mortality (HR 1.60, 95% CI 1.36-1.90). However, this association was no longer significant in the modern era (HR 1.14, 95% CI 0.85-1.50). A sub-analysis showed that using machine perfusion devices for allograft storage was not associated with one-year mortality (HR 1.15, 95% CI 0.79-1.70). Spline analysis demonstrated possible inflection points between 4 and 5 h and 8-9 h in the modern era, and further analysis found that 5-8 h of preservation did not increase one-year mortality (HR 1.09, 95% CI 0.80-1.47) relative to the ≤ 4 h group. In conclusion, the association between cardiac allograft preservation duration and morbidity has decreased in the modern era. Today, a 4-h preservation duration threshold may be too restrictive.

Article	Year
Mitral Valve Translocation: Optimization of Patch Geometry in an Ex Vivo Model of Secondary Mitral Regurgitation. Journal of cardiovascular translational research\| PubMed ID: 34782943	2022
Standardization of Mitral Regurgitation Grading Starts with Abandoning Historical "Plus" Terminology. The Annals of thoracic surgery\| PubMed ID: 35051398	2022
Translocation of the Mitral Valve in an Acute Large Animal Model. Journal of cardiovascular translational research\| PubMed ID: 35175554	2022
Adding Mitral Valve Translocation to the Tool Kit for Treatment of Secondary Mitral Regurgitation. The Annals of thoracic surgery\| PubMed ID: 35339446	2022
Effectiveness of telemedicine in a mitral valve center of excellence. Journal of cardiac surgery\| PubMed ID: 35384054	2022
How To Do It: Mitral Valve Translocation. Innovations (Philadelphia, Pa.)\| PubMed ID: 36988265	2023
Mitral Valve Translocation: A Novel Approach to Repair Secondary Mitral Regurgitation. Innovations (Philadelphia, Pa.)\| PubMed ID: 36988277	2023
Non-resectional cordal repair for Barlow mitral valve disease. The Journal of cardiovascular surgery\| PubMed ID: 38511306	2024
Factors Associated With Permanent Pacemaker Placement After Tricuspid Valve Operations. The Annals of thoracic surgery\| PubMed ID: 39426556	2025
Tricuspid Anterior and Posterior Patch (TRAPP) Repair of Functional Tricuspid Regurgitation. Innovations (Philadelphia, Pa.)\| PubMed ID: 39520090	2024
Tricuspid Anteroposterior Patch Repair: Optimization of Patch Geometry in an Ex Vivo Model. Annals of thoracic surgery short reports\| PubMed ID: 39790146	2024
Understanding preservation time thresholds in the modern era of heart transplantation. Scientific reports\| PubMed ID: 40240451	2025

Rachael Quinn

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