{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T01:51:14Z","timestamp":1793670674791,"version":"4.5.1"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T00:00:00Z","timestamp":1685059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Between 3D-MV reconstruction values and implanted ring sizes, the highest correlation coefficients were provided by commissural width (CW) (0.839; P\u2009&amp;lt;\u20090.001), intertrigonal distance (ITD) (0.796; P\u2009&amp;lt;\u20090.001), annulus area (0.782; P\u2009&amp;lt;\u20090.001), anterior mitral leaflet area (0.767; P\u2009&amp;lt;\u20090.001), anterior\u2013posterior diameter (0.679; P\u2009&amp;lt;\u20090.001) and anterior mitral leaflet length (0.515; P\u2009&amp;lt;\u20090.001). In multivariable regression analysis, only CW and ITD were found to be independent predictors of annuloplasty ring size (R2 = 0.743; P\u2009&amp;lt;\u20090.001). The highest level of agreement was achieved with CW and ITD, and 76.6% of patients received a ring with no &amp;gt;1 ring size difference from the predicted ring sizes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezad212","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T11:49:22Z","timestamp":1685015362000},"source":"Crossref","is-referenced-by-count":11,"title":["Image-based ring size prediction for mitral valve repair"],"prefix":"10.1093","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3479-4537","authenticated-orcid":false,"given":"Serdar","family":"Akansel","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC) , Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6932-7157","authenticated-orcid":false,"given":"Markus","family":"Kofler","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC) , Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin , Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site Berlin , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7498-1989","authenticated-orcid":false,"given":"Karel M","family":"Van Praet","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC) , Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin , Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site Berlin , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4927-1584","authenticated-orcid":false,"given":"Simon H","family":"S\u00fcndermann","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC) , Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin , Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site Berlin , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6201-1600","authenticated-orcid":false,"given":"Marian","family":"Kukucka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin , Berlin, Germany"},{"name":"Department of Anesthesiology, Deutsches Herzzentrum der Charite (DHZC) , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7353-1855","authenticated-orcid":false,"given":"Stephan","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC) , Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin , Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site Berlin , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7911-8620","authenticated-orcid":false,"given":"Volkmar","family":"Falk","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC) , Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin , Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site Berlin , Berlin, Germany"},{"name":"Department of Health Sciences and Technology, ETH Zurich , Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2009-6375","authenticated-orcid":false,"given":"J\u00f6rg","family":"Kempfert","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC) , Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin , Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site Berlin , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,5,26]]},"reference":[{"key":"2023072808455892700_ezad212-B1","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/0003-4975(95)00753-8","article-title":"The \u2018physio-ring\u2019: an advanced concept in mitral valve annuloplasty","volume":"60","author":"Carpentier","year":"1995","journal-title":"Ann Thorac Surg"},{"key":"2023072808455892700_ezad212-B2","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1016\/j.athoracsur.2008.07.073","article-title":"Value of augmented reality enhanced transesophageal echocardiography (TEE) for determining optimal annuloplasty ring size during mitral valve repair","volume":"86","author":"Ender","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2023072808455892700_ezad212-B3","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1016\/S0735-1097(99)00464-7","article-title":"Echocardiographic predictors of left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve after mitral valve reconstruction for myxomatous valve disease","volume":"34","author":"Maslow","year":"1999","journal-title":"J Am Coll Cardiol"},{"key":"2023072808455892700_ezad212-B4","doi-asserted-by":"crossref","first-page":"2787","DOI":"10.1016\/j.jtcvs.2014.07.076","article-title":"Systolic anterior motion of the mitral valve: a 30-year perspective","volume":"148","author":"Loulmet","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023072808455892700_ezad212-B5","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/j.athoracsur.2012.10.023","article-title":"Sizing for mitral annuloplasty: where does science stop and voodoo begin?","volume":"95","author":"Bothe","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2023072808455892700_ezad212-B6","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1093\/icvts\/ivac163","article-title":"Minimally invasive mitral valve surgery after failed transcatheter mitral valve repair in an intermediate-risk cohort","author":"Akansel","year":"2022","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2023072808455892700_ezad212-B7","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/ejcts\/ezs455","article-title":"Guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Vahanian","year":"2012","journal-title":"Eur J Cardiothorac Surg"},{"key":"2023072808455892700_ezad212-B8","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1093\/ejcts\/ezx324","article-title":"ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"52","author":"Falk","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2023072808455892700_ezad212-B9","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1080\/17434440.2021.1894925","article-title":"Mitral valve surgery: current status and future prospects of the minimally invasive approach","volume":"18","author":"Van Praet","year":"2021","journal-title":"Expert Rev Med Devices"},{"key":"2023072808455892700_ezad212-B10","doi-asserted-by":"publisher","DOI":"10.1510\/mmcts.2022.017","article-title":"Endoaortic balloon occlusion in minimally invasive mitral valve surgery","author":"Van Praet","year":"2022","journal-title":"Multimed Man Cardiothorac Surg"},{"key":"2023072808455892700_ezad212-B11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/icvts\/ivy207","article-title":"Statistical primer: checking model assumptions with regression diagnostics","volume":"28","author":"Hickey","year":"2019","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2023072808455892700_ezad212-B12","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1093\/ejcts\/ezt018","article-title":"Clinical registries: governance, management, analysis and applications","volume":"44","author":"Hickey","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"key":"2023072808455892700_ezad212-B13","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1097\/EDE.0b013e3181577654","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for Reporting Observational Studies","volume":"18","author":"von Elm","year":"2007","journal-title":"Epidemiology"},{"key":"2023072808455892700_ezad212-B14","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/S0022-5223(19)39144-5","article-title":"Cardiac valve surgery\u2014the \u201cFrench correction\u201d","volume":"86","author":"Carpentier","year":"1983","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023072808455892700_ezad212-B15","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1161\/CIRCULATIONAHA.112.000699","article-title":"Late outcomes of mitral valve repair for mitral regurgitation due to degenerative disease","volume":"127","author":"David","year":"2013","journal-title":"Circulation"},{"key":"2023072808455892700_ezad212-B16","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1016\/j.jtcvs.2013.08.011","article-title":"Clinical evaluation of functional mitral stenosis after mitral valve repair for degenerative disease: potential affect on surgical strategy","volume":"146","author":"Mesana","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023072808455892700_ezad212-B17","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1016\/j.amjcard.2006.12.072","article-title":"Annular-to-leaflet mismatch and the need for reductive annuloplasty in patients undergoing mitral repair for chronic mitral regurgitation due to mitral valve prolapse","volume":"99","author":"Maisano","year":"2007","journal-title":"Am J Cardiol"},{"key":"2023072808455892700_ezad212-B18","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1016\/j.athoracsur.2006.06.043","article-title":"Large annuloplasty rings facilitate mitral valve repair in Barlow\u2019s disease","volume":"82","author":"Adams","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2023072808455892700_ezad212-B19","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.athoracsur.2007.08.040","article-title":"Restrictive mitral annuloplasty cures ischemic mitral regurgitation and heart failure","volume":"85","author":"Braun","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2023072808455892700_ezad212-B20","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.athoracsur.2019.08.085","article-title":"Novel trigone-based sizing method for mitral ring annuloplasty","volume":"109","author":"Okamoto","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2023072808455892700_ezad212-B21","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1016\/j.hlc.2020.01.018","article-title":"The use of a preoperative mitral valve model to guide mitral valve repair","volume":"29","author":"Pillutla","year":"2020","journal-title":"Heart Lung Circ"},{"key":"2023072808455892700_ezad212-B22","first-page":"445","article-title":"Prediction of the annuloplasty ring size in patients undergoing mitral valve repair using real-time three-dimensional transoesophageal echocardiography","volume":"12","author":"Ender","year":"2011","journal-title":"Eur J Echocardiogr"},{"key":"2023072808455892700_ezad212-B23","first-page":"524","article-title":"Echocardiographic measurements alone do not provide accurate non-invasive selection of annuloplasty band size for robotic mitral valve repair","volume":"15","author":"Cook","year":"2006","journal-title":"J Heart Valve Dis"},{"key":"2023072808455892700_ezad212-B24","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1093\/ejcts\/ezr040","article-title":"Can three-dimensional echocardiography accurately predict complexity of mitral valve repair?","volume":"41","author":"Chikwe","year":"2012","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezad212\/50457192\/ezad212.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/64\/1\/ezad212\/50981336\/ezad212.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/64\/1\/ezad212\/50981336\/ezad212.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T08:47:06Z","timestamp":1690534026000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezad212\/7180274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,26]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezad212","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,7,1]]},"published":{"date-parts":[[2023,5,26]]},"article-number":"ezad212"}}