Mechanical and Structural Evaluation of Tricuspid Bicuspidization in a Porcine Model
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Cardiovascular Engineering and Technology (Ó 2020) https://doi.org/10.1007/s13239-020-00480-0
Original Article
Mechanical and Structural Evaluation of Tricuspid Bicuspidization in a Porcine Model FATIESA SULEJMANI, JOSHUA PATAKY, and WEI SUN Tissue Mechanics Laboratory, The Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 206 Technology Enterprise Park, 387 Technology Circle, Atlanta, GA 30313-2412, USA (Received 12 December 2019; accepted 22 July 2020) Associate Editor Changfu Wu oversaw the review of this article.
Abstract Introduction—Tricuspid regurgitation (TR) affects approximately 1.6 million Americans and is associated with just a 63.9% 1-year survival rate in its moderate to severe forms due to its asymptomatic nature and late diagnosis and surgical referral. As a result, industrial fervor has begun to broach this topic, with several percutaneous treatment devices currently under development. As much remains unknown about the tricuspid apparatus, the mechanics of these procedures remain unquantified. In this study, a testing apparatus and technique for the evaluation of percutaneous tricuspid valve (TV) bicuspidization were developed for the evaluation of these parameters in twelve porcine hearts. Methods—The passive relaxed myocardial state and the active contracted state were each induced in six porcine hearts and the bicuspidization experiment was run twice, the second time after induction of TR. TV annular area, cinching force, static leakage through the TV annulus, and annular ellipticity were quantified and compared among the groups. Results—The use of phenol was effective to induce functional TR by increased annular area. Cinching force was not found to differ between any of the testing states, but the bicuspidization experiment was able to reduce the TR annular area to that of its healthy counterpart in addition to reducing static leakage through the TV annulus. Despite appropriately reducing the area, bicuspidization was found to induce a more circular TV annular shape. Conclusion—Taken together, these results provide a first mechanical analysis of the TV bicuspidization mechanism
Address correspondence to Wei Sun, Tissue Mechanics Laboratory, The Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 206 Technology Enterprise Park, 387 Technology Circle, Atlanta, GA 30313-2412, USA. Electronic mail: [email protected]
and may serve as a point of reference for future clinical animal studies. Keywords—Tricuspid regurgitation, Tricuspid valve, Kay procedure, Transcatheter tricuspid valverepair, Tricuspid annulus, Cinching tension.
INTRODUCTION Heart valve disease, which refers to any abnormal condition involving one or more of the heart valves, affects about 2.5% of Americans.43 Academia and industry have long focused their efforts on the investigation and treatment of left heart valve diseases (aortic and mitral valves), which were thought to be the most prevalent and most c
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