Riccardo Vismara1, Guido Gelpi2, Santosh Prabhu3, Paolo Romitelli4, Lauren G Troxler3, Andrea Mangini5, Claudia Romagnoni2, Monica Contino2, Dylan T Van Hoven3, Federico Lucherini6, Michal Jaworek6, Alberto Redaelli6, Gianfranco B Fiore6, Carlo Antona7. 1. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy. Electronic address: riccardo.vismara@polimi.it. 2. ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Department, 'Luigi Sacco' General Hospital, Milan, Italy. 3. Abbott Vascular, Menlo Park, California. 4. Abbott Vascular International, Brussels, Belgium. 5. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Department, 'Luigi Sacco' General Hospital, Milan, Italy. 6. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy. 7. ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Department, 'Luigi Sacco' General Hospital, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
Abstract
BACKGROUND: Although associated with left heart pathologies, functional tricuspid regurgitation (FTR) is often left untreated during left heart surgery. Hence, owing to its degenerative character, reoperation is often needed, encompassing an impressive (25% to 35%) mortality rate. Thus transcatheter approaches to FTR are raising great interest. OBJECTIVES: The authors evaluated the post-treatment effectiveness of the edge-to-edge technique using the percutaneous mitral valve repair device in an ex vivo pulsatile model of FTR. METHODS: The devices were implanted in 11 porcine hearts simulating FTR. In each heart, single-clip treatments involved grasping leaflet pairs in the medial or commissural position (6 combinations). Two-clip treatments were then performed considering all possible 15 combinations of leaflet pairs and medial/commissural grasping. Cardiac output, mean pulmonary pressure, and mean diastolic valve pressure gradient were evaluated in physiological and simulated pathological conditions (FTR), and post-treatments. RESULTS: Grasping the septal and anterior leaflets allowed for the best post-procedural outcome, ensuring a complete re-establishment of physiological-like hemodynamics. Septal and posterior grasping induced a significant recovery from FTR, although less marked. Conversely, grasping the anterior and posterior leaflets did not reduce FTR, and was detrimental in some specific cases. CONCLUSIONS: This experimental work demonstrated that the transcatheter edge-to-edge repair technique is a feasible approach for FTR. The study investigated this approach to develop a selective, specific structural intervention methodology for treating FTR, considering the several biomechanical factors that alter proper functionality of valvular substructures. These results can be used to guide the development of edge-to-edge repair techniques in treatment of FTR.
BACKGROUND: Although associated with left heart pathologies, functional tricuspid regurgitation (FTR) is often left untreated during left heart surgery. Hence, owing to its degenerative character, reoperation is often needed, encompassing an impressive (25% to 35%) mortality rate. Thus transcatheter approaches to FTR are raising great interest. OBJECTIVES: The authors evaluated the post-treatment effectiveness of the edge-to-edge technique using the percutaneous mitral valve repair device in an ex vivo pulsatile model of FTR. METHODS: The devices were implanted in 11 porcine hearts simulating FTR. In each heart, single-clip treatments involved grasping leaflet pairs in the medial or commissural position (6 combinations). Two-clip treatments were then performed considering all possible 15 combinations of leaflet pairs and medial/commissural grasping. Cardiac output, mean pulmonary pressure, and mean diastolic valve pressure gradient were evaluated in physiological and simulated pathological conditions (FTR), and post-treatments. RESULTS: Grasping the septal and anterior leaflets allowed for the best post-procedural outcome, ensuring a complete re-establishment of physiological-like hemodynamics. Septal and posterior grasping induced a significant recovery from FTR, although less marked. Conversely, grasping the anterior and posterior leaflets did not reduce FTR, and was detrimental in some specific cases. CONCLUSIONS: This experimental work demonstrated that the transcatheter edge-to-edge repair technique is a feasible approach for FTR. The study investigated this approach to develop a selective, specific structural intervention methodology for treating FTR, considering the several biomechanical factors that alter proper functionality of valvular substructures. These results can be used to guide the development of edge-to-edge repair techniques in treatment of FTR.
Authors: Hareem Nisar; Djalal Fakim; Daniel Bainbridge; Elvis C S Chen; Terry Peters Journal: Int J Comput Assist Radiol Surg Date: 2022-05-19 Impact factor: 3.421
Authors: Jan A Krikken; Ad F M van den Heuvel; H Marco Willemsen; Adriaan A Voors; Erik Lipsic Journal: Neth Heart J Date: 2022-03-29 Impact factor: 2.854
Authors: Matthew H Park; Yuanjia Zhu; Annabel M Imbrie-Moore; Hanjay Wang; Mateo Marin-Cuartas; Michael J Paulsen; Y Joseph Woo Journal: Front Cardiovasc Med Date: 2021-07-08