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Review

Mitral valve surgery: current status and future prospects of the minimally invasive approach

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References

  • Carpentier AF, Adams DHFF. Carpentier’s reconstructive valve surgery: from valve analysis to valve reconstruction. 1st edition. 2010. Elsevier Saunders.
  • Van Praet KM, Stamm C, Sündermann SH, et al. Minimally invasive surgical mitral valve repair: state of the art review. Interv Cardiol Rev. 2018;13(1):14–19.
  • Sündermann SH MD, Joerg Seeburger MD PhD, Scherman J MD, et al. Innovations in minimally invasive mitral valve repair. Surg Technol Int. 2012;22:207–212.
  • Greco E, Santamaria V, Rose D, et al. Is not yet time to properly learn endoscopic mitral valve repair? Cir Cardiovasc. 2020;27(3):100–104.
  • Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–1011.
  • Kempfert J, Blumenstein JM, Borger MA, et al. Minimally invasive off-pump valve-in-a-valve implantation: the atrial transcatheter approach for re-operative mitral valve replacement. Eur Heart J. 2008;29(19):2382–2387.
  • Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J. 2010;31(16):1958–1967.
  • Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–2786.
  • Sündermann SH, Falk V, Jacobs S. Mitral valve reconstruction - Surgical techniques and results. Swiss Med Wkly. 2012Nov;142:1–9.
  • Van Praet KM, Kofler M, Sündermann SH, et al. Minimally invasive approach for infective mitral valve endocarditis. Ann Cardiothorac Surg. 2019;8(6):702–704.
  • Miceli A, Murzi M, Canarutto D, et al. Minimally invasive mitral valve repair through right minithoracotomy in the setting of degenerative mitral regurgitation: early outcomes and long-term follow-up. Ann Cardiothorac Surg. 2015;4(5):422–427.
  • Welp H, Martens S. Minimally invasive mitral valve repair. Curr Opin Anaesthesiol. 2014;27(1):65–71.
  • Thourani VH, Weintraub WS, Guyton RA, et al. Outcomes and long-term survival for patients undergoing mitral valve repair versus replacement: effect of age and concomitant coronary artery bypass grafting. Circulation. 2003;108(3):298–304.
  • Ruvolo G, Speziale G, Bianchini R, et al. Combined coronary bypass grafting and mitral valve surgery: early and late results. Thorac Cardiovasc Surg. 1995;43(2):90–93.
  • Girdauskas E, Pausch J, Harmel E, et al. Minimally invasive mitral valve repair for functional mitral regurgitation. Eur J Cardiothorac Surg. 2019;55:17–25.
  • Acker MA, Parides MK, Perrault LP, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med. 2014;370(1):23–32.
  • Salmasi MY, Acharya M, Humayun N, et al. Is valve repair preferable to valve replacement in ischaemic mitral regurgitation? A systematic review and meta-analysis. Eur J Cardio Thoracic Surg. 2016;50(1):17–28.
  • Glauber M, Miceli A. State of the art for approaching the mitral valve: sternotomy, minimally invasive or total endoscopic robotic? Eur J Cardio Thoracic Surg. 2015;48(5):639–641.
  • Vanermen H, Farhat F, Wellens F, et al. Minimally invasive video-assisted mitral valve surgery: from port-access towards a totally endoscopic procedure. J Card Surg. 2000;15:51–60.
  • Van Praet KM, Kofler M, Montagner M, et al. Minimally invasive mitral valve repair using external clamping — pearls and pitfalls. J Vis Surg. 2020;6:45.
  • Van Praet KM, Stamm C, Sündermann SH, et al. Minimally invasive cardiac surgery removal of an interatrial intraseptal bronchogenic cyst through a periareolar approach. Innov (Phila). 2018;13(3):230–232. http://journals.lww.com/innovjournal
  • Van Praet KM, Kofler M, Unbehaun A, et al. Reply to Del Giglio, Tamagnini, Biondi, and Di Mauro. J Card Surg. 2020;4–7. DOI:10.1111/jocs.14998.
  • Meyer A, Van Kampen A, Kiefer P, et al. Minithoracotomy versus full sternotomy for isolated aortic valve replacement: propensity matched data from two centers. J Card Surg. 2020. DOI:10.1111/jocs.15177. Online ahead of print.
  • Nersesian G, Van Praet KM, Van Kampen A, et al. Surgical treatment of outflow graft kinking complicated by external obstruction with a fibrin mass in a patient with LVAD. J Card Surg. 2020;35(10):2853–2856.
  • Chan EY, Lumbao DM, Iribarne A, et al. Evolution of cannulation techniques for minimally invasive cardiac surgery. Innov (Phila). 2012;7(1):9–14.
  • Van Praet KM, Kofler M, Jacobs S, et al. The MANTA vascular closure device for percutaneous femoral vessel cannulation in minimally invasive surgical mitral valve repair. Innov. 2020;1–4. DOI:10.1177/1556984520956300.
  • Ender J, Borger MA, Scholz M, et al. Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the leipzig fast-track concept. Anesthesiology. 2008;109(1):61–66.
  • Parnell A, Prince M. Anaesthesia for minimally invasive cardiac surgery. BJA Educ. 2018;18(10):323–330. DOI:10.1016/j.bjae.2018.06.004.
  • Szelkowski LA, Puri NK, Singh R, et al. Current trends in preoperative, intraoperative, and postoperative care of the adult cardiac surgery patient. Curr Probl Surg. 2015;52(1):531–569.
  • Chan MJ, Chung T, Glassford NJ, et al. Spectroscopy in adult cardiac surgery patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2017;31(4):1155–1165.
  • Zhang C, Yue J, Li M, et al. Bronchial blocker versus double-lumen endobronchial tube in minimally invasive cardiac surgery. BMC Pulm Med. 2019;19(1):1–5.
  • Grocott HP, Darrow TR, Whiteheart DL, et al. Lung isolation during port-access cardiac surgery: double-lumen endotracheal tube versus single-lumen endotracheal tube with a bronchial blocker. J Cardiothorac Vasc Anesth. 2003;17(6):725–727.
  • Ender J, Sgouropoulou S. Value of transesophageal echocardiography (TEE) guidance in minimally invasive mitral valve surgery. Ann Cardiothorac Surg. 2013;2(6):796–802.
  • Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the american society of echocardiography and the society of cardiovascular anesthesiologists. J Am Soc Echocardiogr. 2013;26(9):921–964.
  • Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr. 2017;30(4):303–371.
  • Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013;14(7):611–644.
  • Chew PG, Bounford K, Plein S, et al. Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg. 2018;8(3):342–359.
  • Hagendorff A, Doenst T, Falk V. Echocardiographic assessment of functional mitral regurgitation: opening Pandora’s box? ESC Hear Fail. 2019;6(4):678–685.
  • Desjardins G, Cahalan M. The impact of routine Trans-oesophageal Echocardiography (TOE) in cardiac surgery. Best Pract Res Clin Anaesthesiol. 2009;23(3):263–271.
  • Nicoara A, Skubas N, Ad N, et al. Guidelines for the use of transesophageal echocardiography to assist with surgical decision-making in the operating room: a surgery-based approach: from the American society of echocardiography in collaboration with the society of cardiovascular anesthesi. J Am Soc Echocardiogr. 2020;33(6):692–734.
  • Ender J, Singh R, Nakahira J, et al. Visualization of the circumflex artery in the perioperative setting with transesophageal echocardiography. Anesth Analg. 2012;115(1):22–26.
  • Van Praet KM, Stamm C, Starck CT, et al. An overview of surgical treatment modalities and emerging transcatheter interventions in the management of tricuspid valve regurgitation. Expert Rev Cardiovasc Ther. 2018;16(2):75–89.
  • Bonaros N, Höfer D, Holfeld J, et al. Cannulation of the carotid artery for minimally invasive mitral or tricuspid valve surgery. Ann Thorac Surg. 2020;110(6):e517–e519.
  • Crosby AD, Sistino JJ. Impact of pre-bypass autologous blood collection on blood transfusion rates. J Extra Corpor Technol. 2019;51(3):140–146.
  • Albes JM, Stöhr IM, Kaluza M, et al. Physiological coagulation can be maintained in extracorporeal circulation by means of shed blood separation and coating. J Thorac Cardiovasc Surg. 2003;126(5):1504–1512.
  • Baker RA, Nikolic A, Onorati F, et al. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery: a tool to better clinical practice. Eur J Cardio Thoracic Surg. 2020;57(2):207–209.
  • Ranucci M, Johnson I, Willcox T, et al. Goal-directed perfusion to reduce acute kidney injury: a randomized trial. J Thorac Cardiovasc Surg. 2018;156(5):1918–1927.e2.
  • Srey R, Rance G, Shapeton AD, et al. A quick reference tool for goal-directed perfusion in cardiac surgery. J Extra Corpor Technol. 2019;51(3):172–174.
  • Siddiqi S, Blackstone EH, Bakaeen FG. Bretschneider and del Nido solutions: are they safe for coronary artery bypass grafting? If so, how should we use them? J Card Surg. 2018;33(5):229–234.
  • Westerberg M, Bengtsson A, Jeppsson A. Coronary surgery without cardiotomy suction and autotransfusion reduces the postoperative systemic inflammatory response. Ann Thorac Surg. 2004;78(1):54–59.
  • Vercaemst L. Hemolysis in cardiac surgery patients undergoing cardiopulmonary bypass : a review in search of a treatment algorithm. J Extracorpor Technol. 2008;40(3):257–267.
  • Blackshear P, Dorman F, Steinbach J. Some mechanical effects that influence hemolysis. Trans Am Soc Artif Intern Organs. 1965;11:112–117.
  • Ringgaard S, Madsen T, Pedersen E, et al. Quantitative evaluation of flow patterns in perfusion cannulae by a new magnetic resonance imaging method. Perfusion. 1997;12(6):411–416.
  • Merkle F, Kurtovic D, Matschke A, et al. Simulation-based training of critical events during cardiopulmonary bypass: importance of a critical events checklist. Perfus (United Kingdom). 2020. DOI:10.1177/0267659120937125
  • Zang X, Huang HL, Xie B, et al. A comparative study of three-dimensional high-definition and two-dimensional high-definition video systems in totally endoscopic mitral valve replacement. J Thorac Dis. 2019;11(3):788–794.
  • Hawkins RB, Mehaffey JH, Mullen MM, et al. A propensity matched analysis of robotic, minimally invasive, and conventional mitral valve surgery. Heart. 2018;1970–1975. DOI:10.1136/heartjnl-2018-313129.
  • Bonatti J, Schachner T, Bonaros N, et al. Technical challenges in totally endoscopic robotic coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2006;131(1):146–153.
  • Ailawadi G, Agnihotri AK, Mehall JR, et al. Minimally invasive mitral valve surgery i - patient selection, evaluation, and planning. Innov (Phila). 2016;11(4):243–250.
  • Van Der Merwe J, Casselman F, Stockman B, et al. Late redo-port access surgery after port access surgery. Interact Cardiovasc Thorac Surg. 2016;22(1):13–18.
  • Rival PM, Moore THM, McAleenan A, et al. Transthoracic clamp versus endoaortic balloon occlusion in minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J Cardio Thoracic Surg. 2019;56(4):643–653.
  • Barbero C, Krakor R, Bentala M, et al. Comparison of endoaortic and transthoracic aortic clamping in less-invasive mitral valve surgery. Ann Thorac Surg. 2018;105(3):794–798.
  • Aybek T, Dogan S, Westphal K, et al. Operation comparing the port-access technique and the transthoracic clamp technique. J Card Surg. 2000;15(1):76–81.
  • Reichenspurner H, Detter C, Deuse T, et al. Vedio and robotic-assisted minimally invasive mitral valve surgery : a comparison of the port- access and transthoracic clamp techniques. Ann Thorac Surg. 2005;79(2):485–490.
  • Liebold A, Skrabal C, Emini R, et al. Improved outcome of minimally invasive mitral surgery with IntraClude aortic balloon occlusion compared to transthoracic clamping. Pap Present 14 ISMICS; May 28–31, 2014, Boston, MA. http://epostersonline.s3.amazonaws.com/ismics2014/ismics201409c0088NORMAL.:2
  • Casselman F, Aramendi J, Bentala M, et al. Endoaortic clamping does not increase the risk of stroke in minimal access mitral valve surgery: a multicenter experience. Ann Thorac Surg. 2015;100(4):1334–1339.
  • Atluri P, Goldstone AB, Fox J, et al. Port access cardiac operations can be safely performed with either endoaortic balloon or chitwood clamp. Ann Thorac Surg. 2014;98(5):1579–1584.
  • Modi P, Rodriguez E, Clark W, et al. Minimally invasive video-assisted mitral valve surgery : a 12-year, 2-center experience in 1178 patients. J Thorac Cardiovasc Surg. 2019;137(6):1481–1487.
  • Krapf C, Wohlrab P, Häußinger S, et al. Remote access perfusion for minimally invasive cardiac surgery : to clamp or to in fl ate? †. Eur J Cardiothorac Surg. 2013;44(5):898–904.
  • Kempfert J, Meyer A, Cetinkaya A et al. Propensity matched comparison of endoclamping versus direct aortic clamping for minimally invasive mitral valve surgery. Pap Present 15 ISMICS; June 3–6, 2015, Berlin, Ger. [cited 2016 Jan 31]. Available from: http://meetings.ismics.org/abstracts/2015/P99.cgi
  • Ad N, Holmes SD, Shuman DJ, et al. Minimally invasive mitral valve surgery without aortic cross-clamping and with femoral cannulation is not associated with increased risk of stroke compared with traditional mitral valve surgery: a propensity score-matched analysis. Eur J Cardio Thoracic Surg. 2015;48(6):868–872.
  • Umakanthan R, Leacche M, Petracek MR, et al. Safety of minimally invasive mitral valve surgery without aortic cross-clamp. Ann Thorac Surg. 2008;85(5):1544–1549.
  • Gammie JS, Zhao Y, Peterson ED, et al. Less-invasive mitral valve operations : trends and outcomes from the society of thoracic surgeons adult cardiac surgery database. ATS. 2019;90(5):1401–1410.e1.
  • Mazine A, Pellerin M, Dionne P, et al. Minimally invasive mitral valve surgery : influence of aortic clamping technique on early outcomes. Ann Thorac Surg. 2013;96(6):2116–2122.
  • Aybek T, Dogan S, Westphal K, et al. Operation comparing the port-access technique and the transthoracic clamp technique. J Card Surg. 2000;15(1):76–81.
  • Kowalewski M, Malvindi PG, Suwalski P, et al. Clinical safety and effectiveness of endoaortic as compared to transthoracic clamp for small thoracotomy mitral valve surgery: meta-analysis of observational studies. Ann Thorac Surg. 2017;103(2):676–686.
  • Beckmann A, Meyer R, Lewandowski J, et al. German heart surgery report 2017: the annual updated registry of the german society for thoracic and cardiovascular surgery. Thorac Cardiovasc Surg. 2019;67:331–344.
  • Nissen AP, Miller CC, Thourani VH, et al. Less invasive mitral surgery versus conventional sternotomy stratified by mitral pathology. Ann Thorac Surg. 2020. DOI:10.1016/j.athoracsur.2020.05.145.
  • Schneider F, Onnasch JF, Falk V, et al. Cerebral microemboli during minimally invasive and conventional mitral valve operations. Ann Thorac Surg. 2000;70(3):1094–1097.
  • Cheng DCH, Martin J, Lal A, et al. Minimally invasive versus conventional open mitral valve surgery: a meta-analysis and systematic review. Innov Technol Tech Cardiothorac Vasc Surg. 2011;2:84–103.
  • Doenst T, Diab M, Sponholz C, et al. The opportunities and limitations of minimally invasive cardiac surgery. Dtsch Arztebl Int. 2017;114(46):777–784.
  • Akansel S, Suendermann SH, Kofler M, et al. A successful minimally invasive mitral valve repair following delayed device embolization in a patient with Pascal device implantation. Turkish J Thorac Cardiovasc Surg. 2020;28(2):404–406.
  • Akansel S, Sündermann SH, Kofler M, et al. Surgical explantation of a partially detached cardioband device. J Card Surg. 2020;35(8):2100–2102.
  • Pasic M, Sündermann S, Unbehaun A, et al. Beating heart mitral valve surgery: results in 120 consecutive patients considered unsuitable for conventional mitral valve surgery. Interact Cardiovasc Thorac Surg. 2017;25(4):541–547.
  • Daemen JHT, Heuts S, Olsthoorn JR, et al. Right minithoracotomy versus median sternotomy for reoperative mitral valve surgery: a systematic review and meta-analysis of observational studies. Eur J Cardio Thoracic Surg. 2018;54:817–825.
  • Hawkins RB, Mehaffey JH, Kessel SM, et al. Minimally invasive mitral valve surgery is associated with excellent resource utilization, cost, and outcomes. J Thorac Cardiovasc Surg. 2018;156(2):611–616.e3.
  • Holzhey DM, Seeburger J, Misfeld M, et al. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation. 2013;128(5):483–491.
  • von Oppell UO MF. Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured gore-tex loops. Ann Thorac Surg. 2000;70(6):2166–2168.
  • Gammie JS, Chikwe J, Badhwar V, et al. Isolated mitral valve surgery: the society of thoracic surgeons adult cardiac surgery database analysis. Ann Thorac Surg. 2018;106(3):716–727.
  • Sündermann SH, Czesla M, Kempfert J, et al. Results of mitral valve repair with an adjustable annuloplasty ring 2 years after implantation. Heart Vessels. 2017;32(7):843–849.
  • Lehmann S, Walther T, Kempfert J, et al. Stentless mitral valve implantation in comparison to conventional mitral valve repair or replacement at five years. Thorac Cardiovasc Surg. 2006;54(1):10–14.
  • Chikwe J, Toyoda N, Anyanwu AC, et al. Relation of mitral valve surgery volume to repair rate, durability, and survival. J Am Coll Cardiol. 2017;69:2397–2406.
  • Gillinov M, Mick S, Suri RM. The specialty of mitral valve repair. J Am Coll Cardiol. 2017;69(19):2407–2409.
  • Casselman FP, Van Slycke SDH, Lambrechts DL, et al. Endoscopic mitral valve repair: feasible, reproducible and durable. J Thorac Cardiovasc Surg. 2003;125:273–282.
  • Davierwala PM, Seeburger J, Pfannmueller B, et al. Minimally invasive mitral valve surgery: “The Leipzig experience”. Ann Cardiothorac Surg. 2013;2(6):744–750.
  • Seeburger J, Borger MA, Falk V, et al. Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. Eur J Cardiothorac Surg. 2008;34:760–765.
  • Gammie JS, Bartus K, Gackowski A, et al. Safety and performance of a novel transventricular beating heart mitral valve repair system: 1-year outcomes. Eur J Cardiothorac Surg. 2021;59(1):199–206.
  • Gummert JF, Rahmel A, Bucerius J, et al. Al. Mitral valve repair in patients with end stage cardiomyopathy: who benefits? Eur J Cardiothorac Surg. 2003;23:1017–1022. Discussion 1022.
  • Bax JJ, Braun J, Somer ST, et al. Al. Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodelling. Circulation. 2004;110(II):103–108.
  • Kwon MH, Lee LS, Cevasco M, et al. Recurrence of mitral regurgitation after partial versus complete mitral valve ring annuloplasty for functional mitral regurgitation. J Thorac Cardiovasc Surg. 2013 Sep;146(3):616-22. DOI: 10.1016/j.jtcvs.2012.07.049.
  • Maisano F, Alfieri O, Banai S, et al. Clinical update The future of transcatheter mitral valve interventions : competitive or complementary role of repair vs. replacement?. 2015;1651–1659. DOI:10.1093/eurheartj/ehv123.
  • Walczak L, Tautz L, Neugebauer M, et al. Interactive editing of virtual chordae tendineae for the simulation of the mitral valve in a decision support system. Int J Comput Assist Radiol Surg. 2020. DOI:10.1007/s11548-020-02230-y.
  • Neugebauer M, Tautz L, Hüllebrand M, et al. Virtual downsizing for decision support in mitral valve repair. Int J Comput Assist Radiol Surg. 2019;14(2):357–371.
  • Meyer A, Kofler M, Montagner M, et al. Reliability and influence on decision making of fully-automated vs. semi-automated software packages for procedural planning in TAVI. Sci Rep. 2020;10(1):1–8.
  • Kong F, Pham T, Martin C, et al. Finite element analysis of annuloplasty and papillary muscle relocation on a patient-specific mitral regurgitation model. PLoS One. 2018;13(6):1–15.
  • Choi A, Rim Y, Jeffrey S, et al. A novel finite element-based patient-specific mitral valve repair: virtual ring annuloplasty. Biomed Mater Eng. 2014;24(1):341–347.
  • Grbic S. et al. Multi-modal validation framework of mitral valve geometry and functional computational models. In:editors, Camara O, Mansi T, Pop M, et al. Statistical atlases and computational models of the heart - imaging and Modelling Challenges. 5th International Workshop, STACOM 2014, Held in Conjunction with MICCAI 2014, Boston, MA, USA, September 18, 2014.
  • Grbic S, Easley TF, Mansi T, et al., Personalized mitral valve closure computation and uncertainty analysis from 3D echocardiography”.
  • Pouch AM, Wang H, Takabe M, et al., Fully automatic segmentation of the mitral leafets in 3D transesophageal echocardiographic images using multi-atlas joint label fusion and deformable medial m.
  • Sotaquira M, Pepi M, Fusini L, et al. Semi-automated segmentation and quantification of mitral annulus and leaflets from transesophageal 3-D echocardiographic images. Ultrasound Med Biol. 2015 Jan;41(1):251-67. doi:10.1016/j.ultrasmedbio.2014.09.001.
  • Tautz L, et al. Extraction of open-state mitral valve geometry from CT volumes. Int J Comput Assist Radiol Surg. 2018;13(11):1741–1754.
  • Carnahan P, Ginty O, Moore J, et al. “Interactive-automatic segmentation and modelling of the mitral valve.” International Conference on Functional Imaging and Modeling of the Heart. Springer, Cham, 2019.
  • Costa E, Martins N, Saad Sultan M, et al. “Mitral Valve Leaflets Segmentation in Echocardiography using Convolutional Neural Networks*.” 2019 IEEE 6th Portuguese Meeting on Bioengineering (ENBENG), 2019 Feb 22-23: Lisbon, Portugal . p.1–4.
  • Hammer PE, Sacks MS, Nido PJ, et al. Mass-spring model for simulation of heart valve tissue mechanical behavior. Ann Biomed Eng. 2011. 6. 39(6):1668–1679.
  • Villard P-F, Hammer PE, Perrin DP, et al. Fast image-based mitral valve simulation from individualized geometry. The international journal of medical robotics + computer assisted surgery: MRCAS.
  • Vellguth K, et al. Development of a modeling pipeline for the prediction of hemodynamic outcome after virtual mitral valve repair using image-based CFD. Int J Computer Assisted Radiol Surgery (Springer). 2018;13(11):1795-1805. DOI: 10.1007/s11548-018-1821-8.

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