{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T10:16:55Z","timestamp":1773829015199,"version":"3.50.1"},"reference-count":24,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"LARALAB GmbH, Munich, Germany; an Abbott company"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Annuloplasty ring sizing is critical for durable outcomes in surgical mitral valve repair (MVr). However, there is no clear consensus on optimal sizing strategies. Artificial intelligence (AI)-based imaging tools may help to reduce uncertainty in preoperative decision-making by providing objective, reproducible and reliable measurements. This study evaluated the predictive capability of a fully automated, computed tomography (CT)-based AI-driven tool for annuloplasty ring sizing in patients undergoing minimally invasive MVr (MI-MVr). Methods: A total of 71 consecutive patients undergoing MI-MVr for Carpentier type II mitral valve insufficiency during the study period were included. Preoperative CT scans were analyzed using a cloud-based, fully automated AI tool to quantify mitral valve geometric parameters. Correlations between AI-derived measurements and implanted ring sizes were assessed using the Pearson correlation test. Univariable and multivariable linear regression analyses were performed to identify independent predictors of ring size selection. Results: Several AI-derived parameters correlated significantly with implanted ring size, with the strongest correlations observed for commissural width (R = 0.693, p &lt; 0.001) and mitral annular area (R = 0.693, p &lt; 0.001). In multivariable regression analysis, these parameters were the strongest predictors of annuloplasty ring size (R2 = 0.504, p &lt; 0.001). Using this model, accurate annuloplasty ring sizing could be predicted in 78.8% of patients. There were no in-hospital mortality and residual mitral regurgitation at discharge. Conclusions: A fully automated, CT-based AI-driven tool demonstrated good accuracy for preoperative annuloplasty ring size prediction in MI-MVr and may have the potential to support surgical decision-making, reduce operator dependence, and improve reproducibility.<\/jats:p>","DOI":"10.3390\/jcm15062300","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T16:20:14Z","timestamp":1773764414000},"page":"2300","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Potential Role of an Artificial Intelligence-Driven Tool in Decision-Making for Mitral Valve Repair Surgery"],"prefix":"10.3390","volume":"15","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), 13353 Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Dini","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), 13353 Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon H.","family":"S\u00fcndermann","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), 13353 Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilija","family":"Myskinite","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), 13353 Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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), 13353 Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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), 13353 Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site, 10117 Berlin, Germany"},{"name":"Department of Health Sciences and Technology, ETH Zurich, 8057 Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Kempfert","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), 13353 Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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), 13353 Berlin, Germany"},{"name":"Department of Cardiovascular Surgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"},{"name":"DZHK (German Center of Cardiovascular Research), Partner Site, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/SLA.0000000000002693","article-title":"Artificial Intelligence in Surgery: Promises and Perils","volume":"268","author":"Hashimoto","year":"2018","journal-title":"Ann. 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