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Akansel S, Kofler M, Van Praet KM, Sündermann SH, Kukucka M, Jacobs S, Falk V, Kempfert J. Image-based ring size prediction for mitral valve repair. Eur J Cardiothorac Surg 2023:7180274. [PMID: 37233202 DOI: 10.1093/ejcts/ezad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/14/2023] [Accepted: 05/25/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Annuloplasty rings are routinely used in mitral valve repair (MVr). However, accurate annuloplasty ring size selection is essential to obtain a favorable outcome. Moreover, ring sizing can be challenging in some patients and is highly influenced by surgeons' experience. This study investigated the utility of three-dimensional mitral valve (3D-MV) reconstruction models to predict annuloplasty ring size for MVr. METHODS A total of 150 patients undergoing minimally invasive MVr with annuloplasty ring due to Carpentier type II pathology and who were discharged with none/trace residual MR were included. 3D-MV reconstruction models were created with a semi-automated software package (4D MV Analysis; Tomtec Imaging Systems, Munich, Germany) to quantitate MV geometry. To predict the ring size, univariable and multivariable linear regression analyses were performed. RESULTS Between 3D-MV reconstruction values and implanted ring sizes, the highest correlation coefficients were provided by commissural width (CW) (0.839; p < 0.001), intertrigonal distance (ITD) (0.796; p < 0.001), annulus area (0.782; p < 0.001), anterior mitral leaflet area (0.767; p < 0.001), Anterior-posterior diameter (0.679; p < 0.001) and AML length (0.515; p < 0.001). In multivariable regression analysis, only CW and ITD were found to be independent predictors of annuloplasty ring size (R2=0.743; p < 0.001). The highest level of agreement was achieved with CW and ITD, and 76.6% of patients received a ring with no greater than one ring size difference from the predicted ring sizes. CONCLUSIONS 3D-MV reconstruction models can support surgeons in the decision-making process for annuloplasty ring sizing. The present study may be a first step towards accurate annuloplasty ring size prediction using multimodal Machine Learning decision support.
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Affiliation(s)
- Serdar Akansel
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
| | - Markus Kofler
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Karel M Van Praet
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Simon H Sündermann
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Marian Kukucka
- Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
- Deutsches Herzzentrum der Charite (DHZC), Department of Anesthesiology, Berlin, Germany
| | - Stephan Jacobs
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Volkmar Falk
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
- ETH Zurich, Department of Health Sciences and Technology, Zürich, Switzerland
| | - Jörg Kempfert
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
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