Perry Seo Choi, Alexander D Kaiser, Riya Nilkant, Amit Sharir, Umar Siddiqi, Hannah L McMullen, Alison L Marsden, Michael R Ma
{"title":"Simulation-guided outlet valve repair: early integration of computationally-derived principles of free-edge length in bicuspidization repair.","authors":"Perry Seo Choi, Alexander D Kaiser, Riya Nilkant, Amit Sharir, Umar Siddiqi, Hannah L McMullen, Alison L Marsden, Michael R Ma","doi":"10.3389/fcvm.2026.1957668","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Symmetric bicuspidization repair for outlet valve pathologies relies on the surgeon's subjective assessment. Recent computational and ex-vivo work suggests sizing free-edge length to 1.57 times aortic diameter is optimal. This principle was applied clinically at our institution, and this study compares post-implementation outcomes with historical results.</p><p><strong>Methods: </strong>All patients with attempted bicuspidization from 2011 to 2025 were queried. Primary outcome was freedom from valve-related reoperation or valve replacement. Secondary outcomes were cross-clamp time, number of bypass runs, mean transvalvular gradient, and regurgitation grade. Kaplan-Meier curves were generated for primary outcome with log-rank comparison. Secondary outcomes were compared with Wilcoxon rank-sum test.</p><p><strong>Results: </strong>At median age 5.9 years, fourteen patients underwent symmetric bicuspidization (9 historical, 5 simulation-guided). Valve configuration included unicuspid (<i>n</i> = 2), bicuspid (<i>n</i> = 6), tricuspid (<i>n</i> = 4), and quadricuspid (<i>n</i> = 2). Repair indication was predominantly regurgitation (<i>n</i> = 13/14, 93%). Five (56%) historical patients underwent reoperation compared with zero simulation-guided patients (median follow-up 948 vs. 455 days). Three (33%) historical patients required repeat bypass run, compared to zero simulation-guided. Cross-clamp time was not different between groups (72 vs. 89, <i>p</i> = 0.74). Acute and latest postoperative mean gradients were also not significantly different (acute: 13.5 vs. 9.6, <i>p</i> = 0.14; latest: 12.4 vs. 3.3, <i>p</i> = 0.08), though gradient variability was two to four times lower in the simulation-guided group.</p><p><strong>Conclusions: </strong>This exploratory study presents promising early outcomes after prespecified, standardized sizing of the free-edge length in symmetric bicuspidization repair. Simulation-guided design can be applied in complex valve repair and may enhance early outcomes.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1957668"},"PeriodicalIF":3.0000,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658558/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Cardiovascular Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fcvm.2026.1957668","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Symmetric bicuspidization repair for outlet valve pathologies relies on the surgeon's subjective assessment. Recent computational and ex-vivo work suggests sizing free-edge length to 1.57 times aortic diameter is optimal. This principle was applied clinically at our institution, and this study compares post-implementation outcomes with historical results.
Methods: All patients with attempted bicuspidization from 2011 to 2025 were queried. Primary outcome was freedom from valve-related reoperation or valve replacement. Secondary outcomes were cross-clamp time, number of bypass runs, mean transvalvular gradient, and regurgitation grade. Kaplan-Meier curves were generated for primary outcome with log-rank comparison. Secondary outcomes were compared with Wilcoxon rank-sum test.
Results: At median age 5.9 years, fourteen patients underwent symmetric bicuspidization (9 historical, 5 simulation-guided). Valve configuration included unicuspid (n = 2), bicuspid (n = 6), tricuspid (n = 4), and quadricuspid (n = 2). Repair indication was predominantly regurgitation (n = 13/14, 93%). Five (56%) historical patients underwent reoperation compared with zero simulation-guided patients (median follow-up 948 vs. 455 days). Three (33%) historical patients required repeat bypass run, compared to zero simulation-guided. Cross-clamp time was not different between groups (72 vs. 89, p = 0.74). Acute and latest postoperative mean gradients were also not significantly different (acute: 13.5 vs. 9.6, p = 0.14; latest: 12.4 vs. 3.3, p = 0.08), though gradient variability was two to four times lower in the simulation-guided group.
Conclusions: This exploratory study presents promising early outcomes after prespecified, standardized sizing of the free-edge length in symmetric bicuspidization repair. Simulation-guided design can be applied in complex valve repair and may enhance early outcomes.
背景：对称双尖瓣修复出口瓣膜病变依赖于外科医生的主观评价。最近的计算和离体研究表明，将自由边缘长度调整为主动脉直径的1.57倍是最佳的。该原则在我院临床应用，本研究将实施后的结果与历史结果进行比较。方法：对2011 ~ 2025年所有尝试双尖术的患者进行查询。主要结果是无瓣膜相关的再手术或瓣膜置换术。次要结果是交叉钳夹时间、旁路次数、平均跨瓣梯度和反流等级。用log-rank比较生成主要结局的Kaplan-Meier曲线。次要结局比较采用Wilcoxon秩和检验。结果：中位年龄5.9岁，14例患者行对称双尖切开术（9例为历史，5例为模拟引导）。瓣膜配置包括单尖瓣（n = 2）、双尖瓣（n = 6）、三尖瓣（n = 4）和四尖瓣（n = 2）。修复指征以返流为主（n = 13/14, 93%）。与零模拟引导患者相比，5例（56%）既往患者再次手术（中位随访948天对455天）。3例（33%）有病史的患者需要重复搭桥手术，而模拟引导下为零。交叉钳夹时间组间无差异（72 vs 89, p = 0.74）。急性和术后最新平均梯度也无显著差异（急性：13.5 vs. 9.6, p = 0.14；最新：12.4 vs. 3.3, p = 0.08），尽管梯度变异性在模拟引导组低2至4倍。结论：这项探索性研究提出了在对称双尖修复中预先指定标准尺寸的自由边缘长度后有希望的早期结果。仿真引导设计可以应用于复杂的阀门修复，并可以提高早期效果。
期刊介绍：
Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers?
At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
