Basic reconstruction: a program for unique cardiac surgeries has been created in Russia

Russian cardiac surgeons have developed a program for calculating the size of mitral valve flaps. Such data is required for reconstruction from the patient's own pericardium. Thanks to this program, doctors will be several steps closer to a complete reconstruction of the mitral valve — this operation has not yet been performed in Russia. For more information about the development, see the Izvestia article.

Mitral valve reconstruction

The Sechenov University Cardiovascular Surgery Clinic has developed a program that will help cardiac surgeons with mitral valve reconstruction. The difficulty lies in the fact that no one has done a complete reconstruction in Russia, and only isolated clinical cases are mentioned in the world medical literature, the university told Izvestia.

Using the new software, it is possible to calculate the size of the mitral valve flaps for each individual patient in order to carve them out of his own pericardium and completely restore the "non-working" valve. It is enough to add several indicators to the program: weight, height, body mass index of the patient, surface area of the mitral valve, parameters of the length and height of its flap, taken from conventional transthoracic echocardiography.

— Based on these data, the program will create a model of the flap, which can then be intraoperatively cut out of the autopericardium and, after the necessary treatment, implanted in the patient, — said Ilya Vasalatiy, an intern researcher at the Department of Cardiovascular Surgery at Sechenov University.

The software was created based on machine learning technology after dozens of parameters of several hundred patients were analyzed. Currently, cardiac surgeons are improving the program so that it can develop a flap model based on a single value — the diameter of the fibrous ring.

— The idea to do mitral valve plastic surgery with an autopericardium was born after several hundred such operations on the aortic valve were performed at the Cardiovascular Surgery Clinic - we have been doing this for the last 10 years. According to world data, we have the largest database of autopsy studies. This is what allows us to make our mitral valve model as personalized as possible for each individual patient," said Maxim Tkachev, Associate Professor of the Department of Cardiovascular Surgery.

In the near future, cardiac surgeons plan to perform a complete mitral valve reconstruction using an autopericardium in a laboratory animal.

— At the moment, our country has not performed a complete reconstruction of the mitral valve with an autopericardium. The personalization of the mitral valve flap model takes us one step closer to this achievement. We will be able to help thousands of patients with severe organ failure by offering them an alternative to replacing the mitral valve with a mechanical prosthesis. Our development will help patients return to a normal lifestyle and eliminate the use of anticoagulants on an ongoing basis," said Roman Komarov, Director of the Cardiovascular Surgery Clinic.

Surgical Software

Such software can be considered extremely promising, since it is located at the intersection of several stable trends in modern medicine, said Ruslan Permyakov, deputy director of the NTI Competence Center "Technologies of Trusted Interaction" based on TUSUR, market expert at NTI Helsnet. The demand for personalized surgery is growing rapidly: operations based on individual anatomical parameters of the patient, rather than standardized implants, are becoming increasingly valuable. Software capable of modeling the exact dimensions of mitral valve flaps and forming an operational strategy for a specific person increases the effectiveness of intervention, reduces the likelihood of complications and minimizes the risk of errors related to the human factor, he said.

— In addition, the reconstructive cardiac surgery market is almost not saturated with such solutions, and the approach with autopericardial valves is still very rarely used. This creates the potential for international priority, the development of a scientific school and the introduction of technology as a unique clinical product with long—term demand," said the specialist.

The surgical software market as a whole is being transformed by IT technologies and is already moving beyond auxiliary tools. Modern solutions include mathematical modeling, three-dimensional visualization, preoperative planning, simulation of interventions and the use of artificial intelligence to analyze medical images, Ruslan Permyakov said.

The phenotype of that: scientists will increase the accuracy of diagnosis of heart failure

How will the new method make it possible to better predict and treat a dangerous disease?

Robotic surgery systems, navigation platforms, and clinical decision support algorithms are becoming key elements of the operational process, significantly improving the accuracy of manipulations and the predictability of results. At the same time, the concept of digital surgery is being formed, when the patient's data is transformed into a digital model of the organ, and the surgeon is able to predict the outcome even before the intervention. These trends are driving investment growth and generating demand for software products that can integrate with visualization, navigation, and biomechanical modeling, the expert added.

The most promising segments of the surgical software market are programs for intraoperative imaging (which compares the position of an instrument with a 3D model from images in real time), robotic surgery, intraoperative imaging, and telementoring, Stanislav Stragnov, head of the Laboratory for the Analysis of Public Health indicators and digitalization of healthcare, told Izvestia.

— And, of course, software for digital dentistry and orthopedics — traditionally high demand allows for active innovation, and the cost of error here is probably less than when performing neurosurgical operations, — said the expert.

The emergence of software to help with heart valve reconstruction is not an isolated success, but part of a global trend, said Almir Yanborisov, CEO of SocRat. Cardiac surgery, like all medicine, is moving towards the era of precision surgery, where each intervention will be maximally adapted to the unique anatomy and physiology of a particular person. In this process, artificial intelligence will not be a substitute for the surgeon's golden hands and clinical thinking, but their most powerful amplifier, capable of minimizing risks and giving patients not only a saved, but also a fully functioning life, the expert added.