Ex Vivo Model of Functional Mitral Regurgitation Using Deer Hearts
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ORIGINAL ARTICLE
Ex Vivo Model of Functional Mitral Regurgitation Using Deer Hearts Michal Jaworek 1,2 & Andrea Mangini 2,3 & Edoardo Maroncelli 1 & Federico Lucherini 1,2 & Rubina Rosa 2,3 & Eleonora Salurso 1 & Emiliano Votta 1,4 & Carlo Antona 2,3,5 & Gianfranco Beniamino Fiore 1,2 & Riccardo Vismara 1,2 Received: 19 March 2020 / Accepted: 7 September 2020 # The Author(s) 2020
Abstract Transcatheter therapies are emerging for functional mitral regurgitation (FMR) treatment, however there is lack of pathological models for their preclinical assessment. We investigated the applicability of deer hearts for this purpose. 8 whole deer hearts were housed in a pulsatile flow bench. At baseline, all mitral valves featured normal coaptation. The pathological state was induced by 60-minutes intraventricular constant pressurization. It caused mitral annulus dilation (anteroposterior diameter increase from 31.8 ± 5.6 mm to 39.5 ± 4.9 mm, p = 0.001), leaflets tethering (maximal tenting height increase from 7.3 ± 2.5 mm to 12.7 ± 3.4 mm, p < 0.001) and left ventricular diameter increase (from 67.8 ± 7.5 mm to 79.4 ± 6.5 mm, p = 0.004). These geometrical reconfigurations led to restricted mitral valve leaflets motion and leaflet coaptation loss. Preliminary feasibility assessment of two FMR treatments was performed in the developed model. Deer hearts showed ability to dilate under constant pressurization and have potential to be used for realistic preclinical research of novel FMR therapies.
Keywords Mitral valve . Functional mitral regurgitation . Ex vivo . Beating heart model . Preclinical research . Heart valve pathological model . Ischemic mitral regurgitation . Atrial mitral regurgitation
Associate Editor Adrian Chester oversaw the review of this article Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12265-020-10071-y) contains supplementary material, which is available to authorized users. * Michal Jaworek [email protected]
Abbreviations MV Mitral valve MA Mitral annulus PM Papillary muscle FMR Functional mitral regurgitation aFMR Atrial functional mitral regurgitation iFMR Ischemic functional mitral regurgitation AoP Mean aortic pressure CO Cardiac output AVR Aortic regurgitation volume A-P Antero-posterior distance M-L Medio-lateral distance THmax Maximal tenting height CL Coaptation length EL Ellipticity LVd Left ventricular diameter
1
Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133 Milan, Italy
2
ForcardioLab – Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
Introduction
3
Cardiovascular Surgery Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy
4
3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
5
Università degli Studi di Milano, Milan, Italy
Mitral valve (MV) proper functioning is granted by the interaction between mitral annulus (MA), MV leaflets, and papillary muscles (PMs). Geometrical reconfigura
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