Annabel M Imbrie-Moore1, Yuanjia Zhu2, Matthew H Park1, Michael J Paulsen3, Hanjay Wang3, Y Joseph Woo4. 1. Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Mechanical Engineering, Stanford University, Stanford, Calif. 2. Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif. 3. Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif. 4. Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif. Electronic address: joswoo@stanford.edu.
Abstract
OBJECTIVE: New transapical minimally invasive artificial chordae implantation devices are a promising alternative to traditional open-heart repair, with the potential for decreased postoperative morbidity and reduced recovery time. However, these devices can place increased stress on the artificial chordae. We designed an artificial papillary muscle to alleviate artificial chordae stresses and thus increase repair durability. METHODS: The artificial papillary muscle device is a narrow elastic column with an inner core that can be implanted during the minimally invasive transapical procedure via the same ventricular incision site. The device was 3-dimensionally printed in biocompatible silicone for this study. To test efficacy, porcine mitral valves (n = 6) were mounted in a heart simulator, and isolated regurgitation was induced. Each valve was repaired with a polytetrafluoroethylene suture with apical anchoring followed by artificial papillary muscle anchoring. In each case, a high-resolution Fiber Bragg Grating sensor recorded forces on the suture. RESULTS: Hemodynamic data confirmed that both repairs-with and without the artificial papillary muscle device-were successful in eliminating mitral regurgitation. Both the peak artificial chordae force and the rate of change of force at the onset of systole were significantly lower with the device compared with apical anchoring without the device (P < .001 and P < .001, respectively). CONCLUSIONS: Our novel artificial papillary muscle could integrate with minimally invasive repairs to shorten the artificial chordae and behave as an elastic damper, thus reducing sharp increases in force. With our device, we have the potential to improve the durability of off-pump transapical mitral valve repair procedures.
OBJECTIVE: New transapical minimally invasive artificial chordae implantation devices are a promising alternative to traditional open-heart repair, with the potential for decreased postoperative morbidity and reduced recovery time. However, these devices can place increased stress on the artificial chordae. We designed an artificial papillary muscle to alleviate artificial chordae stresses and thus increase repair durability. METHODS: The artificial papillary muscle device is a narrow elastic column with an inner core that can be implanted during the minimally invasive transapical procedure via the same ventricular incision site. The device was 3-dimensionally printed in biocompatible silicone for this study. To test efficacy, porcine mitral valves (n = 6) were mounted in a heart simulator, and isolated regurgitation was induced. Each valve was repaired with a polytetrafluoroethylene suture with apical anchoring followed by artificial papillary muscle anchoring. In each case, a high-resolution Fiber Bragg Grating sensor recorded forces on the suture. RESULTS: Hemodynamic data confirmed that both repairs-with and without the artificial papillary muscle device-were successful in eliminating mitral regurgitation. Both the peak artificial chordae force and the rate of change of force at the onset of systole were significantly lower with the device compared with apical anchoring without the device (P < .001 and P < .001, respectively). CONCLUSIONS: Our novel artificial papillary muscle could integrate with minimally invasive repairs to shorten the artificial chordae and behave as an elastic damper, thus reducing sharp increases in force. With our device, we have the potential to improve the durability of off-pump transapical mitral valve repair procedures.
Authors: Andrea Colli; Fabio Zucchetta; Chad Kliger; Roberto Bellu; Marco Francone; Pietro Sedati; Vladimir Jelnin; Carlos E Ruiz; Erica Manzan; Laura Besola; Eleonora Bizzotto; Gino Gerosa Journal: JACC Cardiovasc Imaging Date: 2017-05-17
Authors: Andrew B Goldstone; Jeffrey E Cohen; Jessica L Howard; Bryan B Edwards; Alexandra L Acker; William Hiesinger; John W MacArthur; Pavan Atluri; Y Joseph Woo Journal: Ann Thorac Surg Date: 2015-04-09 Impact factor: 4.330
Authors: Annabel M Imbrie-Moore; Michael J Paulsen; Akshara D Thakore; Hanjay Wang; Camille E Hironaka; Haley J Lucian; Justin M Farry; Bryan B Edwards; Jung Hwa Bae; Mark R Cutkosky; Y Joseph Woo Journal: Ann Thorac Surg Date: 2019-03-02 Impact factor: 4.330
Authors: A Marc Gillinov; Eugene H Blackstone; Edward R Nowicki; Worawong Slisatkorn; Ghannam Al-Dossari; Douglas R Johnston; Kristopher M George; Penny L Houghtaling; Brian Griffin; Joseph F Sabik; Lars G Svensson Journal: J Thorac Cardiovasc Surg Date: 2008-03-04 Impact factor: 5.209
Authors: Michael A Acker; Michael K Parides; Louis P Perrault; Alan J Moskowitz; Annetine C Gelijns; Pierre Voisine; Peter K Smith; Judy W Hung; Eugene H Blackstone; John D Puskas; Michael Argenziano; James S Gammie; Michael Mack; Deborah D Ascheim; Emilia Bagiella; Ellen G Moquete; T Bruce Ferguson; Keith A Horvath; Nancy L Geller; Marissa A Miller; Y Joseph Woo; David A D'Alessandro; Gorav Ailawadi; Francois Dagenais; Timothy J Gardner; Patrick T O'Gara; Robert E Michler; Irving L Kron Journal: N Engl J Med Date: 2013-11-18 Impact factor: 91.245
Authors: Matthew H Park; Pearly K Pandya; Yuanjia Zhu; Danielle M Mullis; Hanjay Wang; Annabel M Imbrie-Moore; Robert Wilkerson; Mateo Marin-Cuartas; Y Joseph Woo Journal: Cardiovasc Eng Technol Date: 2022-08-08 Impact factor: 2.305
Authors: Annabel M Imbrie-Moore; Yuanjia Zhu; Tabitha Bandy-Vizcaino; Matthew H Park; Robert J Wilkerson; Y Joseph Woo Journal: Ann Biomed Eng Date: 2021-11-03 Impact factor: 4.219
Authors: Matthew H Park; Annabel M Imbrie-Moore; Yuanjia Zhu; Robert J Wilkerson; Hanjay Wang; Grant H Park; Catherine A Wu; Pearly K Pandya; Danielle M Mullis; Mateo Marin-Cuartas; Y Joseph Woo Journal: Ann Biomed Eng Date: 2022-10-20 Impact factor: 4.219
Authors: Yuanjia Zhu; Annabel M Imbrie-Moore; Robert J Wilkerson; Michael J Paulsen; Matthew H Park; Y Joseph Woo Journal: BMC Cardiovasc Disord Date: 2022-02-26 Impact factor: 2.298
Authors: Matthew H Park; Mateo Marin-Cuartas; Annabel M Imbrie-Moore; Robert J Wilkerson; Pearly K Pandya; Yuanjia Zhu; Hanjay Wang; Michael A Borger; Y Joseph Woo Journal: JTCVS Tech Date: 2022-01-26
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