{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:38:32Z","timestamp":1790696312741,"version":"4.1.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,10,22]],"date-time":"2019-10-22T00:00:00Z","timestamp":1571702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL089315-01"],"award-info":[{"award-number":["R01HL089315-01"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["17POST33410497"],"award-info":[{"award-number":["17POST33410497"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["18POST33990223"],"award-info":[{"award-number":["18POST33990223"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Stanford Graduate Fellowship in Science and Engineering"},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title\/>\n                  <jats:p\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Posterior ventricular anchoring neochordal (PVAN) repair is a non-resectional technique for correcting mitral regurgitation (MR) due to posterior leaflet prolapse, utilizing a single suture anchored in the myocardium behind the leaflet. This technique has demonstrated clinical efficacy, although a theoretical limitation is stability of the anchoring suture. We hypothesize that the PVAN suture positions the leaflet for coaptation, after which forces are distributed evenly with low repair suture forces.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Porcine mitral valves were mounted in a 3-dimensional-printed heart simulator and chordal forces, haemodynamics and echocardiography were collected at baseline, after inducing MR by severing chordae, and after PVAN repair. Repair suture forces were measured with a force-sensing post positioned to mimic in vivo suture placement. Forces required to pull the myocardial suture free were also determined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Relative primary and secondary chordae forces on both leaflets were elevated during prolapse (P\u2009&amp;lt;\u20090.05). PVAN repair eliminated MR in all valves and normalized chordae forces to baseline levels on anterior primary (0.37\u2009\u00b1\u20090.23 to 0.22\u2009\u00b1\u20090.09 N, P\u2009&amp;lt;\u20090.05), posterior primary (0.62\u2009\u00b1\u20090.37 to 0.14\u2009\u00b1\u20090.05 N, P\u2009=\u20090.001), anterior secondary (1.48\u2009\u00b1\u20090.52 to 0.85\u2009\u00b1\u20090.43 N, P\u2009&amp;lt;\u20090.001) and posterior secondary chordae (1.42\u2009\u00b1\u20090.69 to 0.59\u2009\u00b1\u20090.17 N, P\u2009=\u20090.005). Repair suture forces were minimal, even compared to normal primary chordae forces (0.08\u2009\u00b1\u20090.04 vs 0.19\u2009\u00b1\u20090.08 N, P\u2009=\u20090.002), and were 90 times smaller than maximum forces tolerated by the myocardium (0.08\u2009\u00b1\u20090.04 vs 6.9\u2009\u00b1\u20091.3 N, P\u2009&amp;lt;\u20090.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>DISCUSSION<\/jats:title>\n                  <jats:p>PVAN repair eliminates MR by positioning the posterior leaflet for coaptation, distributing forces throughout the valve. Given extremely low measured forces, the strength of the repair suture and the myocardium is not a limitation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezz258","type":"journal-article","created":{"date-parts":[[2019,8,28]],"date-time":"2019-08-28T11:40:13Z","timestamp":1566992413000},"page":"535-544","source":"Crossref","is-referenced-by-count":37,"title":["Mitral chordae tendineae force profile characterization using a posterior ventricular anchoring neochordal repair model for mitral regurgitation in a three-dimensional-printed <i>ex vivo<\/i> left heart simulator"],"prefix":"10.1093","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1730-0678","authenticated-orcid":false,"given":"Michael J","family":"Paulsen","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabel M","family":"Imbrie-Moore","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA"},{"name":"Department of Mechanical Engineering, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanjay","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9910-7171","authenticated-orcid":false,"given":"Jung Hwa","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille E","family":"Hironaka","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5288-8991","authenticated-orcid":false,"given":"Justin M","family":"Farry","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley J","family":"Lucian","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshara D","family":"Thakore","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"John W","family":"MacArthur","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4730-0900","authenticated-orcid":false,"given":"Mark R","family":"Cutkosky","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y Joseph","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA"},{"name":"Department of Bioengineering, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,22]]},"reference":[{"key":"2021012411094535100_ezz258-B1","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jtcvs.2011.12.054","article-title":"A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines","volume":"144","author":"Castillo","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021012411094535100_ezz258-B2","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1016\/j.athoracsur.2014.12.076","article-title":"A \u201crepair-all\u201d strategy for degenerative mitral valve disease safely minimizes unnecessary replacement","volume":"99","author":"Goldstone","year":"2015","journal-title":"Ann Thorac Surg"},{"key":"2021012411094535100_ezz258-B3","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1161\/CIRCULATIONAHA.107.188525","article-title":"Percutaneous and minimally invasive valve procedures: a scientific statement from the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group","volume":"117","author":"Rosengart","year":"2008","journal-title":"Circulation"},{"key":"2021012411094535100_ezz258-B4","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/S0096-5588(20)30604-8","article-title":"Circumferential suture of the mitral ring; a method for the surgical correction of mitral insufficiency","volume":"30","author":"Davila","year":"1955","journal-title":"J Thorac Surg"},{"key":"2021012411094535100_ezz258-B5","first-page":"446","article-title":"Surgical correction of pure mitral insufficiency by annuloplasty under direct vision","volume":"77","author":"Lillehei","year":"1957","journal-title":"J Lancet"},{"key":"2021012411094535100_ezz258-B6","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.ejcts.2009.07.044","article-title":"Factors influencing survival and postoperative quality of life after mitral valve reconstruction","volume":"37","author":"Hansen","year":"2010","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021012411094535100_ezz258-B7","doi-asserted-by":"crossref","DOI":"10.1016\/S0022-5223(20)31841-9","article-title":"Repair of mitral insufficiency due to ruptured chordae tendineae","author":"Mcgoon","year":"1960","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021012411094535100_ezz258-B8","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/S0003-4975(10)62895-0","article-title":"Conservative management of the prolapsed mitral valve","volume":"26","author":"Carpentier","year":"1978","journal-title":"Ann Thorac Surg"},{"key":"2021012411094535100_ezz258-B9","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1016\/j.athoracsur.2011.07.087","article-title":"Butterfly resection is safe and avoids systolic anterior motion in posterior leaflet prolapse repair","volume":"92","author":"Asai","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2021012411094535100_ezz258-B10","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.jtcvs.2006.09.024","article-title":"Systolic anterior motion after mitral valve repair: is surgical intervention necessary?","volume":"133","author":"Brown","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021012411094535100_ezz258-B11","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1115\/1.2792276","article-title":"A three-dimensional computational investigation of intraventricular fluid dynamics: examination into the initiation of systolic anterior motion of the mitral valve leaflets","volume":"117","author":"Yoganathan","year":"1995","journal-title":"J Biomech Eng"},{"key":"2021012411094535100_ezz258-B12","first-page":"193","article-title":"Patterns of systolic stress distribution on mitral valve anterior leaflet chordal apparatus. A structural mechanical theoretical analysis","volume":"41","author":"Nazari","year":"2000","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"2021012411094535100_ezz258-B13","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.ejcts.2008.01.013","article-title":"Early and mid-term results of mitral valve repair using premeasured Gore-Tex loops (\u2018loop technique\u2019)","volume":"33","author":"Kuntze","year":"2008","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021012411094535100_ezz258-B14","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1053\/j.optechstcvs.2015.10.003","article-title":"Myxomatous mitral valve repair: loop neochord technique","volume":"20","author":"Neely","year":"2015","journal-title":"Oper Tech Thorac Cardiovasc Surg"},{"key":"2021012411094535100_ezz258-B15","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.jtcvs.2011.08.024","article-title":"Simplified nonresectional leaflet remodeling mitral valve repair for degenerative mitral regurgitation","volume":"143","author":"Woo","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021012411094535100_ezz258-B16","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/j.athoracsur.2013.05.053","article-title":"Nonresectional single-suture leaflet remodeling for degenerative mitral regurgitation facilitates minimally invasive mitral valve repair","volume":"96","author":"MacArthur","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2021012411094535100_ezz258-B17","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ijcard.2015.03.239","article-title":"Non-resectional leaflet remodeling mitral valve repair preserves leaflet mobility: a quantitative echocardiographic analysis of mitral valve configuration","volume":"186","author":"Shudo","year":"2015","journal-title":"Int J Cardiol"},{"key":"2021012411094535100_ezz258-B18","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1093\/ejcts\/ezt092","article-title":"Posterior ventricular anchoring neochordal repair of degenerative mitral regurgitation efficiently remodels and repositions posterior leaflet prolapse","volume":"44","author":"Woo","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021012411094535100_ezz258-B19","article-title":"Modeling conduit choice for valve-sparing aortic root replacement on biomechanics with a 3-dimensional-printed heart simulator","author":"Paulsen","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021012411094535100_ezz258-B20","article-title":"Development and ex vivo validation of novel force-sensing neochordae for measuring chordae tendineae tension in the mitral valve apparatus using optical fibers with embedded Bragg gratings","author":"Paulsen","journal-title":"J Biomech Eng 2019 (in press)"},{"key":"2021012411094535100_ezz258-B21","doi-asserted-by":"crossref","DOI":"10.1016\/j.athoracsur.2019.01.053","article-title":"Ex vivo biomechanical study of apical versus papillary neochord anchoring for mitral regurgitation","author":"Imbrie-Moore","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"2021012411094535100_ezz258-B22","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00001648-199001000-00010","article-title":"No adjustments are needed for multiple comparisons","volume":"1","author":"Rothman","year":"1990","journal-title":"Epidemiology"},{"key":"2021012411094535100_ezz258-B23","first-page":"337","article-title":"Differential tension between secondary and primary mitral chordae in an acute in vivo porcine model","volume":"11","author":"Lomholt","year":"2002","journal-title":"J Heart Valve Dis"},{"key":"2021012411094535100_ezz258-B24","first-page":"195","article-title":"Anterior mitral basal \u201cstay\u201d chords are essential for left ventricular geometry and function","volume":"14","author":"Goetz","year":"2005","journal-title":"J Heart Valve Dis"},{"key":"2021012411094535100_ezz258-B25","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s40846-016-0132-1","article-title":"Damage models for soft tissues: a survey","volume":"36","author":"Li","year":"2016","journal-title":"J Med Biol Eng"},{"key":"2021012411094535100_ezz258-B26","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.athoracsur.2009.12.057","article-title":"Chordal replacement versus quadrangular resection for repair of isolated posterior mitral leaflet prolapse","volume":"89","author":"Lange","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"2021012411094535100_ezz258-B27","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/S1010-7940(00)00352-3","article-title":"Mitral-valve repair without annuloplasty rings: results after repair of anterior leaflet versus posterior-leaflet defects using polytetrafluoroethylene sutures for chordal replacement","volume":"17","author":"Duebener","year":"2000","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021012411094535100_ezz258-B28","first-page":"416","article-title":"Animal models of mitral regurgitation induced by mitral valve chordae tendineae rupture","volume":"21","author":"Leroux","year":"2012","journal-title":"J Heart Valve Dis"},{"key":"2021012411094535100_ezz258-B29","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1538\/expanim.18-0045","article-title":"The characteristics of a porcine mitral regurgitation model","volume":"67","author":"Li","year":"2018","journal-title":"Exp Anim"},{"key":"2021012411094535100_ezz258-B30","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1046\/j.1469-7580.1998.19310105.x","article-title":"Anatomy of the pig heart: comparisons with normal human cardiac structure","volume":"193(Pt 1)","author":"Crick","year":"1998","journal-title":"J Anatomy"},{"key":"2021012411094535100_ezz258-B31","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1046\/j.1469-7580.1998.19240573.x","article-title":"Structure of chordae tendineae in the left ventricle of the human heart","volume":"192","author":"Millington-Sanders","year":"1998","journal-title":"J Anatomy"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/57\/3\/535\/36089730\/ezz258.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/57\/3\/535\/36089730\/ezz258.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,24]],"date-time":"2021-01-24T16:10:03Z","timestamp":1611504603000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/57\/3\/535\/5602438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,22]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,10,22]]},"published-print":{"date-parts":[[2020,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezz258","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,3]]},"published":{"date-parts":[[2019,10,22]]}}}