Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany.
Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Eur J Cardiothorac Surg. 2023 Jul 3;64(1). doi: 10.1093/ejcts/ezad212.
Annuloplasty rings are routinely used in mitral valve repair (MVr). However, accurate annuloplasty ring size selection is essential to obtain a favourable 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.
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 mitral regurgitation were included. 3D-MV reconstruction models were created with a semi-automated software package (4D MV Analysis) to quantitate mitral valve geometry. To predict the ring size, univariable and multivariable linear regression analyses were performed.
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 anterior mitral leaflet 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 >1 ring size difference from the predicted ring sizes.
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.
瓣环成形术环在二尖瓣修复（MVr）中常规使用。然而，准确选择瓣环成形术环的大小对于获得良好的结果至关重要。此外，在某些患者中环的尺寸选择可能具有挑战性，并且高度受外科医生经验的影响。本研究探讨了三维二尖瓣（3D-MV）重建模型在预测 MVr 瓣环成形术环大小方面的应用。
共纳入 150 例因 Carpentier Ⅱ型病变行微创 MVr 伴瓣环成形术并出院时无/微量残余二尖瓣反流的患者。使用半自动软件包（4D MV 分析）创建 3D-MV 重建模型以定量二尖瓣几何形状。为了预测环的大小，进行了单变量和多变量线性回归分析。
在 3D-MV 重建值和植入环大小之间，提供最高相关系数的是瓣环交界宽度（CW）（0.839；P<0.001）、三尖瓣环后瓣叶间距离（ITD）（0.796；P<0.001）、瓣环面积（0.782；P<0.001）、前瓣叶面积（0.767；P<0.001）、前-后直径（0.679；P<0.001）和前瓣叶长度（0.515；P<0.001）。多变量回归分析发现，只有 CW 和 ITD 是瓣环成形术环大小的独立预测因子（R2=0.743；P<0.001）。CW 和 ITD 之间的一致性最高，76.6%的患者接受的环与预测环之间的差值不超过 1 个环尺寸。
3D-MV 重建模型可以为外科医生的瓣环成形术环尺寸决策提供支持。本研究可能是使用多模态机器学习决策支持准确预测瓣环成形术环大小的第一步。
