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Park C, Singh M, Saeed MY, Nguyen CT, Roche ET. Biorobotic hybrid heart as a benchtop cardiac mitral valve simulator. DEVICE 2024; 2:100217. [PMID: 38312504 PMCID: PMC10836162 DOI: 10.1016/j.device.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
In this work, we developed a high-fidelity beating heart simulator that provides accurate mitral valve pathophysiology. The benchtop platform is based on a biorobotic hybrid heart that combines preserved intracardiac tissue with soft robotic cardiac muscle providing dynamic left ventricular motion and precise anatomical features designed for testing intracardiac devices, particularly for mitral valve repair. The heart model is integrated into a mock circulatory loop, and the active myocardium drives fluid circulation producing physiological hemodynamics without an external pulsatile pump. Using biomimetic soft robotic technology, the heart can replicate both ventricular and septal wall motion, as well as intraventricular pressure-volume relationships. This enables the system to recreate the natural motion and function of the mitral valve, which allows us to demonstrate various surgical and interventional techniques. The biorobotic cardiovascular simulator allows for real-time hemodynamic data collection, direct visualization of the intracardiac procedure, and compatibility with clinical imaging modalities.
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Affiliation(s)
- Clara Park
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
| | - Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
| | - Mossab Y. Saeed
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA 02115
| | - Christopher T. Nguyen
- Cardiovascular Research Center, Massachusetts General Hospital; Charlestown, MA, USA 02114
- Cardiovascular Innovation Research Center, Heart Vascular Thoracic Institute, Cleveland Clinic; Cleveland, OH, USA 44195
- Imaging Sciences, Imaging Institute, Cleveland Clinic; Cleveland, OH, USA 44195
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic; Cleveland, OH, USA 44196
| | - Ellen T. Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
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2
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Aguado-Sierra J, Brigham R, Baron AK, Gomez PD, Houzeaux G, Guerra JM, Carreras F, Filgueiras-Rama D, Vazquez M, Iaizzo PA, Iles TL, Butakoff C. HPC Framework for Performing in Silico Trials Using a 3D Virtual Human Cardiac Population as Means to Assess Drug-Induced Arrhythmic Risk. Methods Mol Biol 2024; 2716:307-334. [PMID: 37702946 DOI: 10.1007/978-1-0716-3449-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Following the 3 R's principles of animal research-replacement, reduction, and refinement-a high-performance computational framework was produced to generate a platform to perform human cardiac in-silico clinical trials as means to assess the pro-arrhythmic risk after the administrations of one or combination of two potentially arrhythmic drugs. The drugs assessed in this study were hydroxychloroquine and azithromycin. The framework employs electrophysiology simulations on high-resolution three-dimensional, biventricular human heart anatomies including phenotypic variabilities, so as to determine if differential QT-prolongation responds to drugs as observed clinically. These simulations also reproduce sex-specific ionic channel characteristics. The derived changes in the pseudo-electrocardiograms, calcium concentrations, as well as activation patterns within 3D geometries were evaluated for signs of induced arrhythmia. The virtual subjects could be evaluated at two different cycle lengths: at a normal heart rate and at a heart rate associated with stress as means to analyze the proarrhythmic risks after the administrations of hydroxychloroquine and azithromycin. Additionally, a series of experiments performed on reanimated swine hearts utilizing Visible Heart® methodologies in a four-chamber working heart model were performed to verify the arrhythmic behaviors observed in the in silico trials.The obtained results indicated similar pro-arrhythmic risk assessments within the virtual population as compared to published clinical trials (21% clinical risk vs 21.8% in silico trial risk). Evidence of transmurally heterogeneous action potential prolongations after providing a large dose of hydroxychloroquine was found as the observed mechanisms for elicited arrhythmias, both in the in vitro and the in silico models. The proposed workflow for in silico clinical drug cardiotoxicity trials allows for reproducing the complex behavior of cardiac electrophysiology in a varied population, in a matter of a few days as compared to the months or years it requires for most in vivo human clinical trials. Importantly, our results provided evidence of the common phenotype variants that produce distinct drug-induced arrhythmogenic outcomes.
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Affiliation(s)
- Jazmin Aguado-Sierra
- Barcelona Supercomputing Center, Barcelona, Spain.
- Elem Biotech S.L., Barcelona, Spain.
| | - Renee Brigham
- Visible Heart® Laboratories, Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | | | | | - Jose M Guerra
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Francesc Carreras
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - David Filgueiras-Rama
- Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERCV, Madrid, Spain
| | - Mariano Vazquez
- Barcelona Supercomputing Center, Barcelona, Spain
- Elem Biotech S.L., Barcelona, Spain
| | - Paul A Iaizzo
- Visible Heart® Laboratories, Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Tinen L Iles
- Department of Surgery, Medical School, University of Minnesota, Minneapolis, MN, USA
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3
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Zhang H, Patton HN, Wood GA, Yan P, Loew LM, Acker CD, Walcott GP, Rogers JM. Optical mapping of cardiac electromechanics in beating in vivo hearts. Biophys J 2023; 122:4207-4219. [PMID: 37775969 PMCID: PMC10645561 DOI: 10.1016/j.bpj.2023.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023] Open
Abstract
Optical mapping has been widely used in the study of cardiac electrophysiology in motion-arrested, ex vivo heart preparations. Recent developments in motion artifact mitigation techniques have made it possible to optically map beating ex vivo hearts, enabling the study of cardiac electromechanics using optical mapping. However, the ex vivo setting imposes limitations on optical mapping such as altered metabolic states, oversimplified mechanical loads, and the absence of neurohormonal regulation. In this study, we demonstrate optical electromechanical mapping in an in vivo heart preparation. Swine hearts were exposed via median sternotomy. Voltage-sensitive dye, either di-4-ANEQ(F)PTEA or di-5-ANEQ(F)PTEA, was injected into the left anterior descending artery. Fluorescence was excited by alternating green and amber light for excitation ratiometry. Cardiac motion during sinus and paced rhythm was tracked using a marker-based method. Motion tracking and excitation ratiometry successfully corrected most motion artifact in the membrane potential signal. Marker-based motion tracking also allowed simultaneous measurement of epicardial deformation. Reconstructed membrane potential and mechanical deformation measurements were validated using monophasic action potentials and sonomicrometry, respectively. Di-5-ANEQ(F)PTEA produced longer working time and higher signal/noise ratio than di-4-ANEQ(F)PTEA. In addition, we demonstrate potential applications of the new optical mapping system including electromechanical mapping during vagal nerve stimulation, fibrillation/defibrillation. and acute regional ischemia. In conclusion, although some technical limitations remain, optical mapping experiments that simultaneously image electrical and mechanical function can be conducted in beating, in vivo hearts.
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Affiliation(s)
- Hanyu Zhang
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Haley N Patton
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Garrett A Wood
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ping Yan
- R. D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Leslie M Loew
- R. D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Corey D Acker
- R. D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Gregory P Walcott
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jack M Rogers
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama.
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4
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Higuita ML, Jain R, Osho AA, Rabi SA, Pruett TL, Pierson RN, Iaizzo PA, Tessier SN. Novel Imaging Technologies for Accurate Assessment of Cardiac Allograft Performance. CURRENT TRANSPLANTATION REPORTS 2023; 10:100-109. [PMID: 39015560 PMCID: PMC11251714 DOI: 10.1007/s40472-023-00400-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/18/2024]
Abstract
Purpose of the Review The current lack of objective and quantitative assessment techniques to determine cardiac graft relative viability results in risk-averse decision-making, which negatively impact the utilization of cardiac grafts. The purpose of this review is to highlight the current deficiencies in cardiac allograft assessment before focusing on novel cardiac assessment techniques that exploit conventional and emerging imaging modalities, including ultrasound, magnetic resonance, and spectroscopy. Recent Findings Extensive work is ongoing by the scientific community to identify improved objective metrics and tools for cardiac graft assessment, with the goal to safely increasing the number and proportion of hearts accepted for transplantation. Summary This review briefly discusses the in situ and ex vivo tools currently available for clinical organ assessment, before focusing on the individual capabilities of ultrasound, magnetic resonance, and spectroscopy to provide insightful, non-invasive information regarding cardiac graft functional and metabolic status that may be used to predict outcome after transplantation.
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Affiliation(s)
- Manuela Lopera Higuita
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children, Boston, MA, USA
| | - Rohil Jain
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children, Boston, MA, USA
| | - Asishana A. Osho
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, MA, Boston, USA
| | - S. Alireza Rabi
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, MA, Boston, USA
| | - Timothy L. Pruett
- Division of Solid Organ Transplantation and Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Richard N. Pierson
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul A. Iaizzo
- Visible Heart Laboratories, Departments of Surgery and Biomedical EngineeringInstitute for Engineering in Medicine, University of Minnesota, MN 55455 Minneapolis, USA
| | - Shannon N. Tessier
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children, Boston, MA, USA
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5
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Kos B, Mattison L, Ramirez D, Cindrič H, Sigg DC, Iaizzo PA, Stewart MT, Miklavčič D. Determination of lethal electric field threshold for pulsed field ablation in ex vivo perfused porcine and human hearts. Front Cardiovasc Med 2023; 10:1160231. [PMID: 37424913 PMCID: PMC10326317 DOI: 10.3389/fcvm.2023.1160231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Pulsed field ablation is an emerging modality for catheter-based cardiac ablation. The main mechanism of action is irreversible electroporation (IRE), a threshold-based phenomenon in which cells die after exposure to intense pulsed electric fields. Lethal electric field threshold for IRE is a tissue property that determines treatment feasibility and enables the development of new devices and therapeutic applications, but it is greatly dependent on the number of pulses and their duration. Methods In the study, lesions were generated by applying IRE in porcine and human left ventricles using a pair of parallel needle electrodes at different voltages (500-1500 V) and two different pulse waveforms: a proprietary biphasic waveform (Medtronic) and monophasic 48 × 100 μs pulses. The lethal electric field threshold, anisotropy ratio, and conductivity increase by electroporation were determined by numerical modeling, comparing the model outputs with segmented lesion images. Results The median threshold was 535 V/cm in porcine ((N = 51 lesions in n = 6 hearts) and 416 V/cm in the human donor hearts ((N = 21 lesions in n = 3 hearts) for the biphasic waveform. The median threshold value was 368 V/cm in porcine hearts ((N = 35 lesions in n = 9 hearts) cm for 48 × 100 μs pulses. Discussion The values obtained are compared with an extensive literature review of published lethal electric field thresholds in other tissues and were found to be lower than most other tissues, except for skeletal muscle. These findings, albeit preliminary, from a limited number of hearts suggest that treatments in humans with parameters optimized in pigs should result in equal or greater lesions.
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Affiliation(s)
- Bor Kos
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Lars Mattison
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN, United States
| | - David Ramirez
- Department of Surgery, Visible Heart® Laboratories, University of Minnesota, Minneapolis, MN, United States
| | - Helena Cindrič
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Daniel C. Sigg
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN, United States
| | - Paul A. Iaizzo
- Department of Surgery, Visible Heart® Laboratories, University of Minnesota, Minneapolis, MN, United States
| | - Mark T. Stewart
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN, United States
| | - Damijan Miklavčič
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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6
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Valenzuela TF, Iaizzo PA. Post-procedure micro-CT analyses of coronary artery stenting in left main vessels of reanimated and perfusion-fixed human hearts. Biomed Eng Online 2023; 22:27. [PMID: 36934270 PMCID: PMC10024839 DOI: 10.1186/s12938-023-01090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/02/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Percutaneous coronary interventions (PCIs) within left main coronary arteries are high-risk procedures that require optimization of interactions between stent(s) and diseased vessels. Optical Coherence Tomography (OCT) is a widely accepted tool that enhances physicians' ability to assess proper stent appositions during clinical procedures. The primary aim of this study was to develop complementary post-procedure imaging methodologies to better assess and interpret outcomes of left main PCI procedures, utilizing both reanimated and perfusion-fixed human hearts. METHODS PCIs were performed while obtaining OCT scans within the left main anatomies of six human hearts. Subsequently, each heart was scanned with a micro-CT scanner with optimized parameters to achieve resolutions up to 20 µm. Scans were reconstructed and imported into a DICOM segmentation software to generate computational models of implanted stents and associated coronary vessels. 2D images from OCT that were obtained during PCIs were compared to the 3D models generated from micro-CT reconstructions. In addition, the 3D models were utilized to create virtual reality scenes and enlarged 3D prints for development of "mixed reality" tools relative to bifurcation stenting within human left main coronary arteries. RESULTS We developed reproducible methodologies for post-implant analyses of coronary artery stenting procedures. In addition, we generated high-resolution 3D computational models, with ~ 20-micron resolutions, of PCIs performed within reanimated and perfusion-fixed heart specimens. CONCLUSIONS Generated computational models of left main PCIs performed in isolated human hearts can be used to obtain detailed measurements that provide further clinical insights on procedural outcomes. The 3D models from these procedures are useful for generating virtual reality scenes and 3D prints for physician training and education.
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Affiliation(s)
- Thomas F Valenzuela
- Department of Surgery, University of Minnesota, Visible Heart®Laboratories, 420 Delaware St. SE, B172 Mayo, MMC 195, Minneapolis, MN, 55455, USA
| | - Paul A Iaizzo
- Department of Surgery, University of Minnesota, Visible Heart®Laboratories, 420 Delaware St. SE, B172 Mayo, MMC 195, Minneapolis, MN, 55455, USA.
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7
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Valenzuela TF, Schinstock E, Kohnle S, Latib A, Bliagos D, Tunev S, Iaizzo PA. Preclinical research performed on reanimated/perfused swine kidneys: The Visible Kidney™ methodologies. Physiol Rep 2023; 11:e15630. [PMID: 36878878 PMCID: PMC9988650 DOI: 10.14814/phy2.15630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 03/08/2023] Open
Abstract
Preclinical research remains the essential platform in the development and optimization of medical therapies and advancements in translational medicines. However, specifically to animal research, federal laws, and institutional policies require investigators to apply the principles of the 3R's (replacement, reduction, and refinement). The concept of benchtop models utilizing isolated organs, in which multiple variables can be controlled to recreate human function, has been innovative advancements in preclinical research models that adhere to these principles. More specifically, isolated perfused kidney (IPK) models have been invaluable preclinical tools that have led to numerous advancements over the decades, including understanding renal physiology, pharmacologic therapies, and improvements in renal transplantation. However, pre-existing IPK models are not without their own limitations, leaving areas for improvement. An isolated perfused kidney apparatus was designed to best recreate human use conditions as a preclinical tool. Porcine renal blocks were chosen over the more commonly used rodent models, due to their greater similarities to human anatomies. Sixteen porcine kidney pairs obtained en bloc were extracted and placed onto an apparatus where aortic flows, pressures, and overall systemic temperatures were controlled. Organ viability was assessed in 10 renal blocks (n = 8 fresh and n = 2 previously frozen specimens) via both urinary flows and compositions at timepoints up to 180 min. Multimodality imaging, which included fluoroscopy, ultrasound, optical coherence tomography (OCT), and video scopes, was also employed to capture internal and external images to determine renal artery orientations and dimensions. Anatomical measurements and viability assessments of porcine renal blocks were successfully achieved in our perfusion model. Renal main artery diameters averaged smaller in our sample size than in human anatomy while also having more superior takeoff angles. Yet, the average lengths of each main segment were comparable to human anatomy: 32.09 ± 7.97 mm and 42.23 ± 7.33 mm in the left and right renal main artery, respectively. Urine production and urine composition of the fresh renal blocks, when compared to the frozen blocks and baseline perfusate, showed kidney viabilities of up to 3 h via excretion and retention of various metabolites. In this paper, we described a protocol for an isolated perfused kidney apparatus using large mammalian renal blocks. We believe this protocol to be an improvement from similar pre-existing models in better representing human physiologic function while allowing for multimodal imaging. The resulting Visible Kidney™ preclinical model, which has shown viability after isolation and reperfusion, can be a fast and reliable tool for the development of medical devices while also reducing the unnecessary use of animals for research.
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Affiliation(s)
| | | | - Samantha Kohnle
- The Department of Surgery's Visible Heart® Laboratories and the Institute for Engineering in MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Azeem Latib
- Montefiore Medical Center, Albert Einstein College of MedicineThe BronxNew YorkUSA
| | - Dimitrios Bliagos
- Montefiore Medical Center, Albert Einstein College of MedicineThe BronxNew YorkUSA
| | | | - Paul A. Iaizzo
- The Department of Surgery's Visible Heart® Laboratories and the Institute for Engineering in MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
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8
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Bielecki MA, DeVos AN, Bianchini F, Iaizzo PA. Multimodal Imaging of a Chimney-Stenting Procedure Performed Simultaneously with a Transcatheter Aortic Valve Replacement (TAVR) in a Reanimated Human Heart including Post-Implant Analyses. J Cardiovasc Dev Dis 2022; 9:jcdd9120413. [PMID: 36547410 PMCID: PMC9788102 DOI: 10.3390/jcdd9120413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/11/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become a popular treatment option for severe aortic stenosis for patients with a high risk for mortality with surgical aortic valve replacement (SAVR). Coronary artery occlusion (CAO) following the implantation of the device is a potential and sometimes devastating complication of this procedure, that provokes a sudden deterioration of hemodynamic status followed by cardiogenic shock and electrical instability. With patients that present a high risk for coronary obstruction, coronary protection with a chimney stenting technique is an effective strategy that can ensure coronary perfusion during TAVR in case of acute CAO. Utilizing Visible Heart® methodologies, a human heart was reanimated. A chimney stenting technique was implemented simultaneously with the deployment of a Medtronic Evolut™ Pro+ valve (Medtronic PLC; Minneapolis, MN, USA). The entire procedure was recorded utilizing endoscopic cameras, fluoroscopy, optical coherence tomography, and echocardiography. In addition to these procedural visualizations, post-procedural micro-computed tomography (micro-CT) was conducted to provide post-implantation imaging with approximately 60-micron resolution. Utilizing these imaging modalities in a reanimated human heart allows for the unique opportunity to collect data for TAVR procedures in real human anatomies for the subsequent educational uses by the physicians treating aortic valvular disease and/or the designers of future TAVR technologies and procedures.
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Affiliation(s)
- Michael A. Bielecki
- Departments of Surgery and Biomedical Engineering, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence:
| | - Amanda N. DeVos
- Departments of Surgery and Biomedical Engineering, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Francesco Bianchini
- Cardiology, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Metropolitan City of Rome, Italy
| | - Paul A. Iaizzo
- Departments of Surgery and Biomedical Engineering, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
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9
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Singh M, Park C, Roche ET. Decellularization Following Fixation of Explanted Aortic Valves as a Strategy for Preserving Native Mechanical Properties and Function. Front Bioeng Biotechnol 2022; 9:803183. [PMID: 35071211 PMCID: PMC8770733 DOI: 10.3389/fbioe.2021.803183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Mechanical or biological aortic valves are incorporated in physical cardiac simulators for surgical training, educational purposes, and device testing. They suffer from limitations including either a lack of anatomical and biomechanical accuracy or a short lifespan, hence limiting the authentic hands-on learning experience. Medical schools utilize hearts from human cadavers for teaching and research, but these formaldehyde-fixed aortic valves contort and stiffen relative to native valves. Here, we compare a panel of different chemical treatment methods on explanted porcine aortic valves and evaluate the microscopic and macroscopic features of each treatment with a primary focus on mechanical function. A surfactant-based decellularization method after formaldehyde fixation is shown to have mechanical properties close to those of the native aortic valve. Valves treated in this method were integrated into a custom-built left heart cardiac simulator to test their hemodynamic performance. This decellularization, post-fixation technique produced aortic valves which have ultimate stress and elastic modulus in the range of the native leaflets. Decellularization of fixed valves reduced the valvular regurgitation by 60% compared to formaldehyde-fixed valves. This fixation method has implications for scenarios where the dynamic function of preserved valves is required, such as in surgical trainers or device test rigs.
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Affiliation(s)
- Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Clara Park
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
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10
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Holm MA, Emfield K, Iles TL, Iaizzo PA. High-resolution 3D reconstructions of human vasculatures: creation of educational tools and benchtop models for transcatheter devices. Cardiovasc Interv Ther 2021; 37:519-525. [PMID: 34468961 DOI: 10.1007/s12928-021-00804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
Transcatheter therapies are a common way to treat cardiovascular diseases. These therapies are complicated by significant anatomical patient-to-patient variations that exist in terms of transcatheter vascular pathways. Adding to the complexity of transcatheter procedures, the training tools used for physician education often overlook vast patient-to-patient variations and utilize idealized models of patient anatomy that may be unrealistic. In this study, anatomically accurate models were created from high-resolution images of real patient vasculatures. Using fourteen human cadavers donated for research, we collected high-resolution images to generate 3D computational renderings of various patient anatomies. These models make up the "Transcatheter Pathways Vasculature Database" that can be used for physician education and training, as well as improving transcatheter delivery system design. We performed multiple studies that emphasize the anatomical differences that exist in patient vasculatures. Using 3D printing and virtual reality, we developed educational materials and benchtop models to train physicians using true patient anatomies. These tools can also provide device designers with data to improve their products based on real patient vessels. The "Transcatheter Pathways Vasculature Database" highlights differences between patient vasculatures. By educating and training physicians with patient anatomies that accurately represent significant patient-to-patient variations, learning is more translatable to what is seen in the clinic.
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Affiliation(s)
- Mikayle A Holm
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Kendall Emfield
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Tinen L Iles
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Paul A Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA. .,Department of Surgery, University of Minnesota, Minneapolis, MN, USA. .,Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA. .,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA.
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11
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Valenzuela TF, Burzotta F, Iles TL, Lassen JF, Iaizzo PA. Assessment of single and double coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts using Visible Heart® methodologies. Int J Cardiovasc Imaging 2021; 37:2591-2601. [PMID: 33993420 PMCID: PMC8390408 DOI: 10.1007/s10554-021-02240-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
Stent implantation in bifurcated coronary lesions is technically challenging so that procedural refinements are continuously investigated. Novel procedure modeling and intracoronary imaging techniques may offer critical insights on stent deformations and stent-wall interactions during bifurcation stenting procedures. Thus, we assessed coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts. Harvested swine hearts were reanimated using Visible Heart® methodologies and (under standard fluoroscopic guidance) used to test 1-stent (provisional and inverted provisional) and 2-stent (culotte, TAP and DK-crush) techniques on bifurcations within various coronary vessels using commercially available devices. Intracoronary angioscopy and frequency-domain optical-coherence-tomography (OCT) were obtained during the procedures. 3D OCT reconstruction and micro-computed tomography 3D modeling (post heart fixations) were used to assess stent deformations and stent-wall interactions. We conducted multiple stenting procedures and collected unique endoscopic and OCT images (and subsequent computational models from micro-CT) to assess stent deformations and device/wall interactions during different steps of bifurcation stenting procedures. Endoscopy, micro-CT and virtual reality processing documented that different 1- and 2-stent techniques, practiced according to experts’ recommended steps, achieve optimal post-intervention stent conformation. As compared with intra-procedural endoscopy, software-generated 3D OCT images accurately depicted stent deformations during 1-stent techniques. On the opposite, during more complex 2-stent techniques, some defects were appreciated at 3D OCT reconstruction despite optimal 2D OCT images. This study provided unique insights regarding both stent deformations occurring in the course of bifurcation stenting and the efficacy of OCT to visualize them.
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Affiliation(s)
- Thomas F Valenzuela
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA.,Department of Surgery, University of Minnesota, Minneapolis, MN, USA.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168, Rome, Italy. .,Università Cattolica del Sacro Cuore, Milan, Italy.
| | - Tinen L Iles
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, USA.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jens F Lassen
- Department of Cardiology, University of Copenhagen, Copenhagen, Denmark
| | - Paul A Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA.,Department of Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, USA.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
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12
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Zhingre Sanchez JD, Iles TL, Dvir D, Iaizzo PA. Direct visualisation of the BASILICA technique post TAVR to enhance coronary flow. EUROINTERVENTION 2020; 16:680-681. [PMID: 32224479 DOI: 10.4244/eij-d-20-00158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Abstract
PURPOSE OF REVIEW Increasing number of patients with end-stage heart failure and those with improved survivorship from selective utilization of implantable mechanical circulatory support devices have added further burden and complexity to the transplant waitlist and on the rate-limiting availability of donor hearts from the standard pathway of donation after brain death. Unlike this conventional route, the increasing clinical use of donation after circulatory death (DCD) donor hearts necessitates a closer understanding of the logistics involved in the DCD process as well as of the risks associated with the unique pathophysiological consequences in this setting. RECENT FINDINGS Notwithstanding a higher incidence of delayed graft function, the clinical utilization of DCD hearts for cardiac transplantation over the past five years has demonstrated this to be a well-tolerated and strategic alternative with excellent medium-term clinical outcomes. SUMMARY The uptake of DCD heart transplantation remains selective and currently confined to Australia, the United Kingdom, Belgium, and more recently the USA. A more significant adoption will only come about through: a concerted effort to resolve the ethical and clinical controversies; a better understanding of postconditioning strategies; continued resolve to reduce the obligatory period of warm ischemia; and from better extracorporeal platforms that permit functional viability assessment of the DCD donor heart.
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14
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Park C, Fan Y, Hager G, Yuk H, Singh M, Rojas A, Hameed A, Saeed M, Vasilyev NV, Steele TWJ, Zhao X, Nguyen CT, Roche ET. An organosynthetic dynamic heart model with enhanced biomimicry guided by cardiac diffusion tensor imaging. Sci Robot 2020; 5:eaay9106. [PMID: 33022595 PMCID: PMC7545316 DOI: 10.1126/scirobotics.aay9106] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/08/2020] [Indexed: 01/07/2023]
Abstract
The complex motion of the beating heart is accomplished by the spatial arrangement of contracting cardiomyocytes with varying orientation across the transmural layers, which is difficult to imitate in organic or synthetic models. High-fidelity testing of intracardiac devices requires anthropomorphic, dynamic cardiac models that represent this complex motion while maintaining the intricate anatomical structures inside the heart. In this work, we introduce a biorobotic hybrid heart that preserves organic intracardiac structures and mimics cardiac motion by replicating the cardiac myofiber architecture of the left ventricle. The heart model is composed of organic endocardial tissue from a preserved explanted heart with intact intracardiac structures and an active synthetic myocardium that drives the motion of the heart. Inspired by the helical ventricular myocardial band theory, we used diffusion tensor magnetic resonance imaging and tractography of an unraveled organic myocardial band to guide the design of individual soft robotic actuators in a synthetic myocardial band. The active soft tissue mimic was adhered to the organic endocardial tissue in a helical fashion using a custom-designed adhesive to form a flexible, conformable, and watertight organosynthetic interface. The resulting biorobotic hybrid heart simulates the contractile motion of the native heart, compared with in vivo and in silico heart models. In summary, we demonstrate a unique approach fabricating a biomimetic heart model with faithful representation of cardiac motion and endocardial tissue anatomy. These innovations represent important advances toward the unmet need for a high-fidelity in vitro cardiac simulator for preclinical testing of intracardiac devices.
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Affiliation(s)
- Clara Park
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gregor Hager
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Technical University of Munich, Munich, Germany
| | - Hyunwoo Yuk
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- NTU-Northwestern Institute for Nanomedicine, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
| | - Allison Rojas
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aamir Hameed
- Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Mossab Saeed
- Harvard Medical School, Boston, MA, USA
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Nikolay V Vasilyev
- Harvard Medical School, Boston, MA, USA
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Terry W J Steele
- NTU-Northwestern Institute for Nanomedicine, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christopher T Nguyen
- Harvard Medical School, Boston, MA, USA.
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, USA
| | - Ellen T Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
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15
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Bateman MG, Iles TL, Quallich SG, Shaffer AW, Iaizzo PA. Multimodal functional and still imaging of a transplanted human heart reanimated using Visible Heart® methodologies. J Card Surg 2020; 35:668-671. [PMID: 31945224 DOI: 10.1111/jocs.14403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Our research team obtained a human heart with the right lung attached from a recent transplantation patient via a research collaboration with LifeSource, a local organ procurement organization. The heart and lungs were not viable for transplant given the patient's medical history and were subsequently offered to the University of Minnesota for research purposes. METHODS Using Visible Heart® methodologies, we reanimated the specimen en bloc and collected multimodal direct visualization from inside the cardiac chambers and great vessels of the functioning heart. RESULTS Video footage, using videoscopic and fluoroscopic imaging, was captured and is presented in this report as supporting material. Multiple still images highlight the surgical suture sites of the transplantation procedures. CONCLUSIONS This multimodal imaging offers unique educational value for medical students, clinicians, and medical device designers for improving transplantation techniques and patient outcomes.
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Affiliation(s)
- Michael G Bateman
- Visible Heart Laboratories, University of Minnesota, Minneapolis, Minnesota.,Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Tinen L Iles
- Visible Heart Laboratories, University of Minnesota, Minneapolis, Minnesota.,Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | | | - Andrew W Shaffer
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Iaizzo
- Visible Heart Laboratories, University of Minnesota, Minneapolis, Minnesota.,Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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16
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Hołda MK, Zhingre Sanchez JD, Bateman MG, Iaizzo PA. Right Atrioventricular Valve Leaflet Morphology Redefined: Implications for Transcatheter Repair Procedures. JACC Cardiovasc Interv 2019; 12:169-178. [PMID: 30678795 DOI: 10.1016/j.jcin.2018.09.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/20/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The authors aimed to comprehensively detail the right atrioventricular valve functional leaflet anatomies. BACKGROUND The rapid development of both surgical and percutaneous repair techniques for tricuspid regurgitation has renewed interest in variations in the morphology of the right atrioventricular valve. METHODS The functioning right atrioventricular valves of 40 reanimated human hearts were imaged using Visible Heart methodologies. Hearts were then perfusion-fixed and dissected, uniquely allowing for the comparative assessments of functional versus fixed valve anatomies from the same set of donor hearts. RESULTS The right atrioventricular valves have "3-leaflet" configurations in 57.5% and "4-leaflet" configurations in the remaining hearts. For 4-leaflet valves, extra leaflets were commonly observed in the most inferior regions of the annuli. No difference in valve perimeters between 2 valve types were observed (112.2 vs. 117.1 mm; p = 0.14). In 3-leaflet valves, septal, mural, and superior leaflets occupied 32.2 ± 6.5%, 15.9 ± 5.5%, and 25.5 ± 6.2% of the annulus, respectively, whereas in the 4-leaflet arrangements, these values were 27.0 ± 5.8% (septal), 12.0 ± 4.5% (inferior), 13.7 ± 9.4% (mural), and 19.8 ± 6.1% (superior). The muroseptal/inferoseptal commissures were usually located in the cavotricuspid regions, whereas the inferomural and superomural commissures were in the right atrial appendage vestibule area. CONCLUSIONS The right atrioventricular valve has 4 functional leaflets in more than 40% of cases. The authors found that the inferomural region is the most variable area of the valve and believe that anatomic variation is an important consideration for planned interventions.
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Affiliation(s)
- Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University, Kraków, Poland; Department of Cardiac and Vascular Diseases, Jagiellonian University, Kraków, Poland.
| | - Jorge D Zhingre Sanchez
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Michael G Bateman
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota; Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Iaizzo
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota; Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
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17
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Kappler B, Ledezma CA, van Tuijl S, Meijborg V, Boukens BJ, Ergin B, Tan PJ, Stijnen M, Ince C, Díaz-Zuccarini V, de Mol BAJM. Investigating the physiology of normothermic ex vivo heart perfusion in an isolated slaughterhouse porcine model used for device testing and training. BMC Cardiovasc Disord 2019; 19:254. [PMID: 31711426 PMCID: PMC6849278 DOI: 10.1186/s12872-019-1242-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background The PhysioHeart™ is a mature acute platform, based isolated slaughterhouse hearts and able to validate cardiac devices and techniques in working mode. Despite perfusion, myocardial edema and time-dependent function degradation are reported. Therefore, monitoring several variables is necessary to identify which of these should be controlled to preserve the heart function. This study presents biochemical, electrophysiological and hemodynamic changes in the PhysioHeart™ to understand the pitfalls of ex vivo slaughterhouse heart hemoperfusion. Methods Seven porcine hearts were harvested, arrested and revived using the PhysioHeart™. Cardiac output, SaO2, glucose and pH were maintained at physiological levels. Blood analyses were performed hourly and unipolar epicardial electrograms (UEG), pressures and flows were recorded to assess the physiological performance. Results Normal cardiac performance was attained in terms of mean cardiac output (5.1 ± 1.7 l/min) and pressures but deteriorated over time. Across the experiments, homeostasis was maintained for 171.4 ± 54 min, osmolarity and blood electrolytes increased significantly between 10 and 80%, heart weight increased by 144 ± 41 g, free fatty acids (− 60%), glucose and lactate diminished, ammonia increased by 273 ± 76% and myocardial necrosis and UEG alterations appeared and aggravated. Progressively deteriorating electrophysiological and hemodynamic functions can be explained by reperfusion injury, waste product intoxication (i.e. hyperammonemia), lack of essential nutrients, ion imbalances and cardiac necrosis as a consequence of hepatological and nephrological plasma clearance absence. Conclusions The PhysioHeart™ is an acute model, suitable for cardiac device and therapy assessment, which can precede conventional animal studies. However, observations indicate that ex vivo slaughterhouse hearts resemble cardiac physiology of deteriorating hearts in a multi-organ failure situation and signalize the need for plasma clearance during perfusion to attenuate time-dependent function degradation. The presented study therefore provides an in-dept understanding of the sources and reasons causing the cardiac function loss, as a first step for future effort to prolong cardiac perfusion in the PhysioHeart™. These findings could be also of potential interest for other cardiac platforms.
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Affiliation(s)
- Benjamin Kappler
- Department Cardiothoracic Surgery, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, The Netherlands. .,LifeTec Group B.V, Eindhoven, The Netherlands.
| | - Carlos A Ledezma
- Department of Mechanical Engineering, University College London, Torrington Place, London, UK
| | | | - Veronique Meijborg
- Department of Medical Biology, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, The Netherlands
| | - Bastiaan J Boukens
- Department of Medical Biology, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, The Netherlands
| | - Bülent Ergin
- Department of Translational Physiology, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, The Netherlands
| | - P J Tan
- Department of Mechanical Engineering, University College London, Torrington Place, London, UK
| | | | - Can Ince
- Department of Translational Physiology, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, The Netherlands
| | - Vanessa Díaz-Zuccarini
- Department of Mechanical Engineering, University College London, Torrington Place, London, UK. .,WEISS Centre for Surgical and Interventional Sciences, UCL, Gower Street 10, London, UK.
| | - Bas A J M de Mol
- Department Cardiothoracic Surgery, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, The Netherlands.,LifeTec Group B.V, Eindhoven, The Netherlands
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18
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Multimodal imaging of a self-expanding transcatheter aortic valve replacement (TAVR) procedure in a reanimated human heart and post-implant analyses. Int J Cardiovasc Imaging 2019; 35:2135-2137. [DOI: 10.1007/s10554-019-01645-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
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19
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Seewald MS, Gaasedelen EN, Iles TL, Mattison LM, Mattson AR, Schmidt MM, Braun-Dullaeus RC, Iaizzo PA. Effects of ATP administration on isolated swine hearts: Implications for ex vivo perfusion and cardiac transplantation. Exp Biol Med (Maywood) 2019; 244:915-922. [PMID: 31132883 DOI: 10.1177/1535370219850786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Maria S Seewald
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.,2 Department of Cardiology and Angiology, University Hospital Magdeburg, Otto-von-Guericke-Universitӓt Magdeburg, Saxony-Anhalt 39106, Germany
| | - Erik N Gaasedelen
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Tinen L Iles
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.,3 Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Lars M Mattison
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.,4 Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Alexander R Mattson
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.,4 Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Megan M Schmidt
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.,4 Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ruediger C Braun-Dullaeus
- 2 Department of Cardiology and Angiology, University Hospital Magdeburg, Otto-von-Guericke-Universitӓt Magdeburg, Saxony-Anhalt 39106, Germany
| | - Paul A Iaizzo
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.,3 Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
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20
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Howard BT, Iaizzo PA. Induced functional modulations of isolated large mammalian hearts. Pflugers Arch 2019; 471:1095-1101. [PMID: 31123804 DOI: 10.1007/s00424-019-02277-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/25/2019] [Accepted: 04/16/2019] [Indexed: 11/25/2022]
Abstract
In this study we used Visible Heart® methodologies featuring cyclic temperature modulation of porcine hearts in order to establish characteristic temperature responses. This isolated and perfused model is a more predictable and modifiable analog for human heart preservation and isolates the response of the cardiac tissue. We comprehensively monitored isolated porcine hearts undergoing temperature change and demonstrated optimization of isolated cardiac function under mild hypothermia. We tracked metrics of cardiac function as continuous variables during temperature changes (~ 31 to 39 °C), eliciting a well-defined reduction in metabolic demand and in heart rate modulation. Optimization of function appeared to occur around 34.7 ± 0.9 °C (n = 13). Cardiac response was further investigated in the presence of active pacing in order to assess pacing capture and the heart's functional response without a means of regulating rate. Our results may have direct clinical implications for emerging heart preservation methods prior to transplantation, as well as benefits for investigators using isolated heart models for preclinical device testing. Clinically, this porcine model is a basis for finding new ways to extend the window of viability for transplantable organs, thereby restoring or improving graft function and potentially enhancing recipient outcomes.
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Affiliation(s)
- Brian T Howard
- Medtronic Inc., 8200 Coral Sea St NE, Mounds View, MN, 55112, USA
| | - Paul A Iaizzo
- Department of Surgery, University of Minnesota, 420 Delaware St. SE, B172 Mayo, MMC 195, Minneapolis, MN, 55455, USA.
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21
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Ostovar R, Hartrumpf M, Kuehnel RU, Schroeter F, Laux M, Erb M, Claus T, Albes JM. Q-PULS, a new quasi-physiological pulsatile extracorporeal model to simulate heart function. Interact Cardiovasc Thorac Surg 2019; 28:819-825. [PMID: 30517653 DOI: 10.1093/icvts/ivy317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/13/2018] [Accepted: 10/19/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The invention of new surgical procedures requires testing at different stages including animal models. To facilitate this process, we have developed a computer-controlled extracorporeal circulation system for testing of an explanted porcine heart simulating a variety of physiological parameters. Mitral valve function can be assessed before and after induced valve insufficiency and after valve repair. Accordingly, techniques and instruments can be modified at early stages of prototype development. METHODS In the diastole, the left atrium is passively filled through the reservoir. The loading pressure of the atrium and flow rates can be widely adjusted. To simulate the systole, a linear motor-driven piston pump promotes volume into the left ventricle and the aorta. An additional circulatory pump compensates for undesired total emptying of the heart chambers. The processor control of the linear pump allows for various settings of flow rate, velocity and even irregular rhythm. Twenty-one isolated porcine hearts were used. The leaflet movement was filmed using a universal serial bus (USB)-probe camera. RESULTS With 80 mm stroke and 1 m/s speed, a volume of 150 ml can be pumped at a heart rate of up to 73 bpm. Cardiac outputs of up to 10.9 l/min can be achieved. Constant visualization and continuous measurements of the pressure gradients before and after the induction of mitral insufficiency and after repair allowed quantitative verification of repair quality under beating-heart conditions. CONCLUSIONS This model allows a controllable pulsation, loading and unloading of a porcine heart in a wide range. Thus, the function of the leaflets and repair results can be qualitatively and quantitatively evaluated under quasiphysiological conditions.
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Affiliation(s)
- Roya Ostovar
- Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Martin Hartrumpf
- Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Ralf-Uwe Kuehnel
- Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Filip Schroeter
- Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Magdalena Laux
- Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Michael Erb
- Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Thomas Claus
- Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Johannes Maximilian Albes
- Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital, Brandenburg Medical School, Bernau bei Berlin, Germany
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22
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Mattson AR, Yang Z, Iaizzo PA. Direct endoscopic visualization of physiological His-bundle pacing and surrounding anatomy within reanimated human hearts using visible heart methodologies. HeartRhythm Case Rep 2019; 5:209-212. [PMID: 30997336 PMCID: PMC6453149 DOI: 10.1016/j.hrcr.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Alexander R. Mattson
- Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
- Medtronic, Mounds View, Minnesota
| | | | - Paul A. Iaizzo
- Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
- Address reprint requests and correspondence: Dr Paul A. Iaizzo, Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, 420 Delaware St SE, B172 Mayo, MMC 195, Minneapolis, MN 55455.
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23
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Schmidt MM, Benscoter MA, Iaizzo PA. Contact Forces Required to Record Monophasic Action Potentials: A Complement to Catheter Contact Force Measurement. IEEE Trans Biomed Eng 2019; 66:2974-2978. [PMID: 30762527 DOI: 10.1109/tbme.2019.2899554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The ability to monitor catheter contact force (CF) plays a major role in assessing radiofrequency ablation, impacting lesion size and arrhythmia recurrence, and dictating ablation duration and/or overall patient safety. Our study sought to determine the relative CFs required to elicit reproducible monophasic action potential (MAP) recordings. METHODS The study utilized four swine in which: first, median sternotomies were performed and MAPs were collected from seven ventricular locations on the epicardial surface of each heart; and second, a subset of endocardial signals was recorded from a reanimated heart. In these studies, the initial elicitation and then loss of stable MAP waveforms were recorded, as were their associated catheter CFs (n = 371). RESULTS Mean CF at the onset of stable MAP recordings was 14.2 ± 2.9 g for epicardial and 16.6 ± 2.5 g for endocardial locations. Across epicardial locations, no significant differences in CF were required to elicit MAPs. Additionally, endocardial and epicardial CFs for MAPs did not significantly differ for respective locations, i.e., right ventricular septum endocardial versus epicardial. In our study, the catheter CFs required to elicit MAPs were within optimal ranges previously reported for eliciting clinically viable radiofrequency ablations. CONCLUSION We believe that MAP recordings could complement CF measurements with electrical data, providing additional clinical feedback for physicians performing cardiac ablation. SIGNIFICANCE If applied clinically, MAP recordings could potentially improve ablation outcomes in patients with cardiac arrhythmias.
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24
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Greillier P, Ankou B, Bour P, Zorgani A, Abell E, Lacoste R, Bessière F, Pernot M, Catheline S, Quesson B, Chevalier P, Lafon C. Myocardial Thermal Ablation with a Transesophageal High-Intensity Focused Ultrasound Probe: Experiments on Beating Heart Models. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2625-2636. [PMID: 30205993 DOI: 10.1016/j.ultrasmedbio.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
Described here is a study of transesophageal thermal ablation of isolated and perfused beating hearts and non-human primates. An endoscope integrating a transesophageal echocardiography probe and a high-intensity focused ultrasound transducer was built and tested on five Langendorff-isolated hearts and three 30-kg baboons. B-Mode ultrasound, passive elastography and magnetic resonance imaging were performed to monitor thermal lesions. In isolated hearts, continuous and gated sonication parameters were evaluated with acoustic intensities of 9-12 W/cm2. Sonication parameters of gated exposures with 12 W/cm2 acoustic intensity for 5 min consistently produced visible lesions in the ventricles of isolated hearts. In animals, left atria and ventricles were exposed to repeated continuous sonications (4-15 times for 16 s) at an acoustic intensity at the surface of the transducer of 9 W/cm2. Clinical states of the baboons during and after the treatment were good. One suspected lesion in the left ventricle could be evidenced by elastography, but was not confirmed by magnetic resonance imaging. The transesophageal procedure therefore has the potential to create thermal lesions in beating hearts and its safety in clinical practice seems promising. However, further technical exploration of the energy deposition in the target would be necessary before the next pre-clinical experiments.
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Affiliation(s)
| | - Bénédicte Ankou
- Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
| | | | - Ali Zorgani
- Universite Lyon, INSERM, UMR1032, LabTAU, Lyon, France
| | | | | | - Francis Bessière
- Universite Lyon, INSERM, UMR1032, LabTAU, Lyon, France; Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
| | - Mathieu Pernot
- Institut Langevin, Ondes et Images, ESPCI ParisTech, CNRS UMR 7587, Paris, France
| | | | | | - Philippe Chevalier
- Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
| | - Cyril Lafon
- Universite Lyon, INSERM, UMR1032, LabTAU, Lyon, France
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25
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Iles TL, Quallich SG, Iaizzo PA. Identification of Radiofrequency Ablation Catheter Parameters That May Induce Intracardiac Steam Pops: Direct Visualization of Elicitation in Reanimated Swine Hearts. J Cardiovasc Transl Res 2018; 12:250-256. [PMID: 30430355 DOI: 10.1007/s12265-018-9844-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/30/2018] [Indexed: 11/27/2022]
Abstract
Radiofrequency, a common ablation modality, is used clinically to terminate cardiac arrhythmias. With excessive heating, complications sometimes occur when the applied energy generates steam pops, which cause release of energy in the form of tissue and/or air emboli. In this study, we investigated numerous parameters potentially associated with intracardiac steam pops including (1) wattage, (2) catheter tip temperature, (3) catheter irrigation, (4) anatomic site, and (5) repeat ablations at a given site. Using unique Visible Heart® methodologies in reanimated swine hearts, we visualized 539 ablations; steam pops developed in 140 of these ablations. The incidence of steam pops significantly increased for both nonirrigated and irrigated ablations at 40 W (p < 0.005), and for nonirrigated ablations with catheter contact angles perpendicular to the tissue or that encompassed larger surface areas (p < 0.05). To minimize the incidence of steam pops, clinicians performing radiofrequency ablations must consider catheter parameters.
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Affiliation(s)
- Tinen L Iles
- Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, 420 Delaware St. SE, B172 Mayo, MMC 195, Minneapolis, MN, 55455, USA
| | - Stephen G Quallich
- Department of Biomedical Engineering and Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Paul A Iaizzo
- Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, 420 Delaware St. SE, B172 Mayo, MMC 195, Minneapolis, MN, 55455, USA.
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Mattson AR, Zhingre Sanchez JD, Iaizzo PA. The fixation tines of the Micra™ leadless pacemaker are atraumatic to the tricuspid valve. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1606-1610. [DOI: 10.1111/pace.13529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/10/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Alexander R. Mattson
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
- Department of Surgery; University of Minnesota; Minneapolis MN USA
- Institute for Engineering in Medicine; University of Minnesota; Minneapolis MN USA
- Medtronic; Mounds View MN USA
| | - Jorge D. Zhingre Sanchez
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
- Department of Surgery; University of Minnesota; Minneapolis MN USA
- Institute for Engineering in Medicine; University of Minnesota; Minneapolis MN USA
| | - Paul A. Iaizzo
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
- Department of Surgery; University of Minnesota; Minneapolis MN USA
- Institute for Engineering in Medicine; University of Minnesota; Minneapolis MN USA
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Mattson AR, Mattson E, Mesich ML, Yang Z, Iaizzo PA. Electrical parameters for physiological His-Purkinje pacing vary by implant location in an ex vivo canine model. Heart Rhythm 2018; 16:443-450. [PMID: 30240799 DOI: 10.1016/j.hrthm.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Permanent His-bundle pacing (HBP) is an attractive, perhaps more physiological, alternative to traditional right ventricular pacing. OBJECTIVE The purpose of this study was to utilize direct visualization to more comprehensively understand the anatomy central to HBP, correlating electrical lead performance to implant locations along the His-bundle (HB) pathway. METHODS Canine hearts (n = 5) were isolated and reanimated using Visible Heart methodologies. Medtronic 3830 SelectSecure leads were fixated where His potentials were present. The location of each implant was mapped/binned into 4 regions approximately analogous to the proximal, penetrating, and distal HB. Locational differences in HBP capture and resultant QRS morphology were assessed. RESULTS Average HBP capture thresholds did not significantly vary with respect to implant location (1.0-ms pulse width; P = .48). The resulting QRS morphologies from HB-paced beats varied in relation to implant location. As leads were placed further distally along the HB, the ratio of paced to native QRS complex duration increased (ΔQRSpaced/ΔQRSnative ratios-region 2: 0.84 ± 0.16; region 3: 1.04 ± 0.42; region 4: 1.74 ± 0.86). CONCLUSION We demonstrated correlation between the anatomic locations of HBP lead placement and resultant QRS morphologies in a reanimated canine heart model. Proximal placement along the HB pathway resulted in more favorable QRS morphologies, suggesting improved selective HBP capture, with no significant increase in HBP capture thresholds. Pacing the HB in more proximal pathway locations improved the selectivity of HBP and may confer electrical and anatomic benefits relative to distal HBP.
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Affiliation(s)
- Alexander R Mattson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Medtronic, Mounds View, Minnesota
| | - Elizabeth Mattson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota; Medtronic, Mounds View, Minnesota
| | | | | | - Paul A Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota; Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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Bøtker HE, Hausenloy D, Andreadou I, Antonucci S, Boengler K, Davidson SM, Deshwal S, Devaux Y, Di Lisa F, Di Sante M, Efentakis P, Femminò S, García-Dorado D, Giricz Z, Ibanez B, Iliodromitis E, Kaludercic N, Kleinbongard P, Neuhäuser M, Ovize M, Pagliaro P, Rahbek-Schmidt M, Ruiz-Meana M, Schlüter KD, Schulz R, Skyschally A, Wilder C, Yellon DM, Ferdinandy P, Heusch G. Practical guidelines for rigor and reproducibility in preclinical and clinical studies on cardioprotection. Basic Res Cardiol 2018; 113:39. [PMID: 30120595 PMCID: PMC6105267 DOI: 10.1007/s00395-018-0696-8] [Citation(s) in RCA: 304] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/18/2018] [Accepted: 08/03/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Derek Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
- The National Institute of Health Research, University College London Hospitals Biomedial Research Centre, Research and Development, London, UK
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yon Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Ioanna Andreadou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Salvatore Antonucci
- Department of Biomedical Sciences, CNR Institute of Neuroscience, University of Padova, Via Ugo Bassi 58/B, 35121, Padua, Italy
| | - Kerstin Boengler
- Institute for Physiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Soni Deshwal
- Department of Biomedical Sciences, CNR Institute of Neuroscience, University of Padova, Via Ugo Bassi 58/B, 35121, Padua, Italy
| | - Yvan Devaux
- Cardiovascular Research Unit, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Fabio Di Lisa
- Department of Biomedical Sciences, CNR Institute of Neuroscience, University of Padova, Via Ugo Bassi 58/B, 35121, Padua, Italy
| | - Moises Di Sante
- Department of Biomedical Sciences, CNR Institute of Neuroscience, University of Padova, Via Ugo Bassi 58/B, 35121, Padua, Italy
| | - Panagiotis Efentakis
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Saveria Femminò
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - David García-Dorado
- Experimental Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Zoltán Giricz
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), IIS-Fundación Jiménez Díaz, CIBERCV, Madrid, Spain
| | - Efstathios Iliodromitis
- Second Department of Cardiology, Faculty of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nina Kaludercic
- Department of Biomedical Sciences, CNR Institute of Neuroscience, University of Padova, Via Ugo Bassi 58/B, 35121, Padua, Italy
| | - Petra Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany
| | - Markus Neuhäuser
- Department of Mathematics and Technology, Koblenz University of Applied Science, Remagen, Germany
- Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Essen, Germany
| | - Michel Ovize
- Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Lyon, France
- UMR, 1060 (CarMeN), Université Claude Bernard, Lyon1, Villeurbanne, France
| | - Pasquale Pagliaro
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Michael Rahbek-Schmidt
- Department of Cardiology, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Marisol Ruiz-Meana
- Experimental Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | | | - Rainer Schulz
- Institute for Physiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Andreas Skyschally
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany
| | - Catherine Wilder
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Peter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany.
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Schmidt MM, Hoang T, Iaizzo PA. The Ability to Reproducibly Record Cardiac Action Potentials From Multiple Anatomic Locations: Endocardially and Epicardially, In Situ and In Vitro. IEEE Trans Biomed Eng 2018; 66:159-164. [PMID: 29993414 DOI: 10.1109/tbme.2018.2835777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE For cardiac arrhythmia mapping and ablation procedures, the ability to record focal cardiac action potentials could aid in precisely identifying lesions, scarred tissue, and/or arrhythmic foci. Our study objective was to validate the electrophysiologic properties of a routinely employed large mammalian in vitro working heart model. METHODS Monophasic action potentials (MAPs) were recorded from 18 swine hearts during viable hemodynamic function both in situ (postmedian sternotomy) and in vitro (using Visible Heart methodologies). We placed specially designed mapping catheters in epicardial and endocardial locations. High-quality MAP signals were recorded for up to 2 h, and MATLAB was utilized to evaluate relative duration and temporal/regional changes in waveform morphology. RESULTS MAPs were reproducibly recorded from both epicardial and endocardial locations in situ and in vitro. No significant differences were noted in right atrial endocardial, right ventricular endocardial, right ventricular epicardial, or left atrial epicardial waveforms, when baseline recordings were compared to all other in situ and in vitro time points. Furthermore, MAP duration between right ventricular endocardial and epicardial waveforms was not significantly different, in situ or in vitro. CONCLUSION The use of in vitro models like the Visible Heart is considered invaluable for the study of cardiac arrhythmias, the development of novel therapies, and/or preclinical testing of future cardiac mapping catheters and systems. SIGNIFICANCE Preclinical studies assessing in situ and/or in vitro recorded cardiac monophasic action potentials could be critical for the future development and validation of cardiac devices.
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Schmidt MM, Iaizzo PA. The Visible Heart® project and methodologies: novel use for studying cardiac monophasic action potentials and evaluating their underlying mechanisms. Expert Rev Med Devices 2018; 15:467-477. [PMID: 29989510 DOI: 10.1080/17434440.2018.1493922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION This review describes the utilization of Visible Heart® methodologies for electrophysiologic studies, specifically in the investigation of monophasic action potential (MAP) recordings, with the aim to facilitate new catheter/device design and development that may lead to earlier diagnosis, treatment, and ultimately a higher quality of life for patients with atrial fibrillation. AREAS COVERED We describe the historically proposed mechanisms behind which electrode is responsible for the MAP recording, new catheters for recording these signals, and how Visible Heart methodologies can be utilized to develop and test new technologies for electrophysiologic investigations. EXPERT OPINION When compared to traditional electrogram recordings, MAP waveforms provide clinical information vital to the understanding, diagnosis, and treatment of cardiac arrhythmias. New catheters and ablation technologies are routinely being assessed on reanimated large mammalian hearts (swine and human) in our laboratory. These abilities, combined with continued enhancements in imaging modalities and computational systems for electrical mapping, are being applied to the MAP catheter design process. Through this testing we are hopeful that the time from concept to product can be reduced, and that an array of MAP catheters can be placed in the hands of physicians, where they will improve patient outcomes.
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Affiliation(s)
- Megan M Schmidt
- a Department of Biomedical Engineering , University of Minnesota , Minneapolis , MN , USA
| | - Paul A Iaizzo
- b Department of Surgery , University of Minnesota , Minneapolis , MN , USA
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Vatterott PJ, Eggen MD, Mattson AR, Omdahl PK, Hilpisch KE, Iaizzo PA. Retrieval of a chronically implanted leadless pacemaker within an isolated heart using direct visualization. HeartRhythm Case Rep 2018; 4:167-169. [PMID: 29915709 PMCID: PMC6003439 DOI: 10.1016/j.hrcr.2017.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Michael D Eggen
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota.,Medtronic, Mounds View, Minnesota
| | - Alexander R Mattson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota.,Medtronic, Mounds View, Minnesota
| | | | | | - Paul A Iaizzo
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota.,Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota
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Yeo JM, Tse V, Kung J, Lin HY, Lee YT, Kwan J, Yan BP, Tse G. Isolated heart models for studying cardiac electrophysiology: a historical perspective and recent advances. J Basic Clin Physiol Pharmacol 2018; 28:191-200. [PMID: 28063261 DOI: 10.1515/jbcpp-2016-0110] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/12/2016] [Indexed: 01/25/2023]
Abstract
Experimental models used in cardiovascular research range from cellular to whole heart preparations. Isolated whole hearts show higher levels of structural and functional integration than lower level models such as tissues or cellular fragments. Cardiovascular diseases are multi-factorial problems that are dependent on highly organized structures rather than on molecular or cellular components alone. This article first provides a general introduction on the animal models of cardiovascular diseases. It is followed by a detailed overview and a historical perspective of the different isolated heart systems with a particular focus on the Langendorff perfusion method for the study of cardiac arrhythmias. The choice of species, perfusion method, and perfusate composition are discussed in further detail with particular considerations of the theoretical and practical aspects of experimental settings.
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Affiliation(s)
- Jie Ming Yeo
- School of Medicine, Imperial College London, London
| | - Vivian Tse
- Department of Physiology, McGill University, Montreal, Quebec
| | - Judy Kung
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, SAR, P.R
| | - Hiu Yu Lin
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, SAR, P.R
| | - Yee Ting Lee
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, SAR, P.R
| | - Joseph Kwan
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, SAR, P.R
| | - Bryan P Yan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
| | - Gary Tse
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, P.R
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Hołda MK, Hołda J, Koziej M, Piątek K, Klimek-Piotrowska W. Porcine heart interatrial septum anatomy. Ann Anat 2018; 217:24-28. [PMID: 29458135 DOI: 10.1016/j.aanat.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The left-sided atrial septal pouch (SP), a recently re-discovered anatomical structure within the human interatrial septum, has emerged as a possible source of thrombi formation and a trigger for atrial fibrillation, thereby potentially increasing the risk for ischemic stroke. In many studies, the swine interatrial septum has been used as model of the human heart. Also, possible new strategies and devices for management of the SPs may first be tested in this pig model. Therefore, in this study, we aimed to evaluate swine interatrial septum morphology and to compare it with the human analog, especially in the light of SP occurrence. METHODS A total of 75 swine (Sus scrofa f. domestica) hearts were examined. The interatrial septum morphology was assessed, and SPs were measured. RESULTS The most common variant of the interatrial septum was smooth septum (26.6%) followed by the patent foramen ovale channel and right SP (both 22.7%). No left or double SPs were observed. In 28.0% of all cases the fold of tissue (left septal ridge) was observed on the left side of the interatrial septum in the location where the left-sided SP should be expected. The mean length of the patent foramen ovale channel was 7.1±1.5mm. The mean right SP depth was 6.3±2.2mm, and its ostium width and height were 5.8±1.2 and 5.3±1.6mm, respectively. CONCLUSIONS There are significant differences between human and porcine interatrial septum morphology that should be taken into account during experimental studies. The absence of the left SP in swine results in the inability to use porcine heart as an experimental model for left-sided SP management.
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Affiliation(s)
- Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.
| | - Jakub Hołda
- HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Piątek
- HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland
| | - Wiesława Klimek-Piotrowska
- HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland
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Motta SE, Lintas V, Fioretta ES, Hoerstrup SP, Emmert MY. Off-the-shelf tissue engineered heart valves for in situ regeneration: current state, challenges and future directions. Expert Rev Med Devices 2017; 15:35-45. [PMID: 29257706 DOI: 10.1080/17434440.2018.1419865] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) is continuously evolving and is expected to surpass surgical valve implantation in the near future. Combining durable valve substitutes with minimally invasive implantation techniques might increase the clinical relevance of this therapeutic option for younger patient populations. Tissue engineering offers the possibility to create tissue engineered heart valves (TEHVs) with regenerative and self-repair capacities which may overcome the pitfalls of current TAVR prostheses. AREAS COVERED This review focuses on off-the-shelf TEHVs which rely on a clinically-relevant in situ tissue engineering approach and which have already advanced into preclinical or first-in-human investigation. EXPERT COMMENTARY Among the off-the-shelf in situ TEHVs reported in literature, the vast majority covers pulmonary valve substitutes, and only few are combined with transcatheter implantation technologies. Hence, further innovations should include the development of transcatheter tissue engineered aortic valve substitutes, which would considerably increase the clinical relevance of such prostheses.
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Affiliation(s)
- Sarah E Motta
- a Institute for Regenerative Medicine (IREM) , University of Zurich , Zurich , Switzerland
| | - Valentina Lintas
- a Institute for Regenerative Medicine (IREM) , University of Zurich , Zurich , Switzerland
| | - Emanuela S Fioretta
- a Institute for Regenerative Medicine (IREM) , University of Zurich , Zurich , Switzerland
| | - Simon P Hoerstrup
- a Institute for Regenerative Medicine (IREM) , University of Zurich , Zurich , Switzerland.,b Wyss Translational Center Zurich , University and ETH Zurich , Zurich , Switzerland
| | - Maximilian Y Emmert
- a Institute for Regenerative Medicine (IREM) , University of Zurich , Zurich , Switzerland.,b Wyss Translational Center Zurich , University and ETH Zurich , Zurich , Switzerland.,c Heart Center Zurich , University Hospital Zurich , Zurich , Switzerland
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Petterson NJ, Fixsen LS, Rutten MCM, Pijls NHJ, van de Vosse FN, Lopata RGP. Ultrasound functional imaging in an ex vivo beating porcine heart platform. Phys Med Biol 2017; 62:9112-9126. [PMID: 29053103 DOI: 10.1088/1361-6560/aa9515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In recent years, novel ultrasound functional imaging (UFI) techniques have been introduced to assess cardiac function by measuring, e.g. cardiac output (CO) and/or myocardial strain. Verification and reproducibility assessment in a realistic setting remain major issues. Simulations and phantoms are often unrealistic, whereas in vivo measurements often lack crucial hemodynamic parameters or ground truth data, or suffer from the large physiological and clinical variation between patients when attempting clinical validation. Controlled validation in certain pathologies is cumbersome and often requires the use of lab animals. In this study, an isolated beating pig heart setup was adapted and used for performance assessment of UFI techniques such as volume assessment and ultrasound strain imaging. The potential of performing verification and reproducibility studies was demonstrated. For proof-of-principle, validation of UFI in pathological hearts was examined. Ex vivo porcine hearts (n = 6, slaughterhouse waste) were resuscitated and attached to a mock circulatory system. Radio frequency ultrasound data of the left ventricle were acquired in five short axis views and one long axis view. Based on these slices, the CO was measured, where verification was performed using flow sensor measurements in the aorta. Strain imaging was performed providing radial, circumferential and longitudinal strain to assess reproducibility and inter-subject variability under steady conditions. Finally, strains in healthy hearts were compared to a heart with an implanted left ventricular assist device, simulating a failing, supported heart. Good agreement between ultrasound and flow sensor based CO measurements was found. Strains were highly reproducible (intraclass correlation coefficients >0.8). Differences were found due to biological variation and condition of the hearts. Strain magnitude and patterns in the assisted heart were available for different pump action, revealing large changes compared to the normal condition. The setup provides a valuable benchmarking platform for UFI techniques. Future studies will include work on different pathologies and other means of measurement verification.
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Affiliation(s)
- Niels J Petterson
- Cardiovascular Biomechanics group, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, GEM-Z4.131, 5600 MB Eindhoven, Netherlands
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Zhang H, Iijima K, Huang J, Walcott GP, Rogers JM. Optical Mapping of Membrane Potential and Epicardial Deformation in Beating Hearts. Biophys J 2017; 111:438-451. [PMID: 27463145 DOI: 10.1016/j.bpj.2016.03.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/01/2016] [Accepted: 03/24/2016] [Indexed: 11/26/2022] Open
Abstract
Cardiac optical mapping uses potentiometric fluorescent dyes to image membrane potential (Vm). An important limitation of conventional optical mapping is that contraction is usually arrested pharmacologically to prevent motion artifacts from obscuring Vm signals. However, these agents may alter electrophysiology, and by abolishing contraction, also prevent optical mapping from being used to study coupling between electrical and mechanical function. Here, we present a method to simultaneously map Vm and epicardial contraction in the beating heart. Isolated perfused swine hearts were stained with di-4-ANEPPS and fiducial markers were glued to the epicardium for motion tracking. The heart was imaged at 750 Hz with a video camera. Fluorescence was excited with cyan or blue LEDs on alternating camera frames, thus providing a 375-Hz effective sampling rate. Marker tracking enabled the pixel(s) imaging any epicardial site within the marked region to be identified in each camera frame. Cyan- and blue-elicited fluorescence have different sensitivities to Vm, but other signal features, primarily motion artifacts, are common. Thus, taking the ratio of fluorescence emitted by a motion-tracked epicardial site in adjacent frames removes artifacts, leaving Vm (excitation ratiometry). Reconstructed Vm signals were validated by comparison to monophasic action potentials and to conventional optical mapping signals. Binocular imaging with additional video cameras enabled marker motion to be tracked in three dimensions. From these data, epicardial deformation during the cardiac cycle was quantified by computing finite strain fields. We show that the method can simultaneously map Vm and strain in a left-sided working heart preparation and can image changes in both electrical and mechanical function 5 min after the induction of regional ischemia. By allowing high-resolution optical mapping in the absence of electromechanical uncoupling agents, the method relieves a long-standing limitation of optical mapping and has potential to enhance new studies in coupled cardiac electromechanics.
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Affiliation(s)
- Hanyu Zhang
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenichi Iijima
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jian Huang
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory P Walcott
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jack M Rogers
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama.
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Granegger M, Aigner P, Kitzmüller E, Stoiber M, Moscato F, Michel-Behnke I, Schima H. A passive beating heart setup for interventional cardiology training. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2016. [DOI: 10.1515/cdbme-2016-0160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractRealistic training of cardiologic interventions in a heart catheter laboratory is hardly achievable with simple tools and requires animal experiments. Therefore, first a simple mock circuit connected to a porcine heart mimicking the natural heart motion was developed. In a second step the setup was duplicated to drive both sides of the heart independently to generate motion and physiologic pressures and flows. Using this simple setup cardiologic interventions (arterial and ventricular septal defects ASD/VSD closure) were performed successfully and allowed realistic training under the C-arm, echocardiography, placement of catheters and repair of ASD/VSD. With the second setup flows of up to 4 l/min were achieved in both sides of the heart at maximum left and right ventricular pressures of 80 mm Hg and 30 mm Hg respectively. This method is inexpensive and represents a realistic alternative to training in animal experiments.
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Affiliation(s)
- Marcus Granegger
- 1Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- 2Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, AKH-4L, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Philipp Aigner
- 1Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- 2Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, AKH-4L, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Erwin Kitzmüller
- 3Department for Paediatric Cardiology, Medical University of Vienna, Austria
| | - Martin Stoiber
- 1Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- 2Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, AKH-4L, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Francesco Moscato
- 1Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- 2Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, AKH-4L, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Ina Michel-Behnke
- 3Department for Paediatric Cardiology, Medical University of Vienna, Austria
| | - Heinrich Schima
- 4Department of Cardiac Surgery, Medical University of Vienna, Austria
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Iles TL, Howard B, Howard S, Quallich S, Rolfes C, Richardson E, Iaizzo HR, Iaizzo PA. Testing the Efficacy of Pharmacological Agents in a Pericardial Target Delivery Model in the Swine. J Vis Exp 2016. [PMID: 27500319 DOI: 10.3791/52600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
To date, many pharmacological agents used to treat or prevent arrhythmias in open-heart cases create undesired systemic side effects. For example, antiarrhythmic drugs administered intravenously can produce drops in systemic pressure in the already compromised cardiac patient. While performing open-heart procedures, surgeons will often either create a small port or form a pericardial cradle to create suitable fields for operation. This access yields opportunities for target pharmacological delivery (antiarrhythmic or ischemic preconditioning agents) directly to the myocardial tissue without undesired side effects. We have developed a swine model for testing pharmacological agents for target delivery within the pericardial fluid. While fully anesthetized, each animal was instrumented with a Swan-Ganz catheter as well as left and right ventricle pressure catheters, and pacing leads were placed in the right atrial appendage and the right ventricle. A medial sternotomy was then performed and a pericardial access cradle was created; a plunge pacing lead was placed in the left atrial appendage and a bipolar pacing lead was placed in the left ventricle. Utilizing a programmer and a cardiac mapping system, the refractory period of the atrioventricular node (AVN), atria and ventricles was determined. In addition, atrial fibrillation (AF) induction was produced utilizing a Grass stimulator and time in AF was observed. These measurements were performed prior to treatment, as well as 30 min and 60 min after pericardial treatment. Additional time points were added for selected studies. The heart was then cardiopleged and reanimated in a four chamber working mode. Pressure measurements and function were recorded for 1 hr after reanimation. This treatment strategy model allowed us to observe the effects of pharmacological agents that may decrease the incidence of cardiac arrhythmias and/or ischemic damage, during and after open-heart surgery.
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Goff RP, Howard BT, Quallich SG, Iles TL, Iaizzo PA. The novel in vitro reanimation of isolated human and large mammalian heart-lung blocs. BMC PHYSIOLOGY 2016; 16:4. [PMID: 27259478 PMCID: PMC4893289 DOI: 10.1186/s12899-016-0023-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 05/24/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND In vitro isolated heart preparations are valuable tools for the study of cardiac anatomy and physiology, as well as for preclinical device testing. Such preparations afford investigators a high level of hemodynamic control, independent of host or systemic interactions. Here we hypothesize that recovered human and swine heart-lung blocs can be reanimated using a clear perfusate and elicit viable cardiodynamic and pulmonic function. Further, this approach will facilitate multimodal imaging, which is particularly valuable for the study of both functional anatomy and device-tissue interactions. Five human and 18 swine heart-lung preparations were procured using techniques analogous to those for cardiac transplant. Specimens were then rewarmed and reperfused using modifications of a closed circuit, isolated, beating and ventilated heart-lung preparation. Positive pressure mechanical ventilation was also employed, and epicardial defibrillation was applied to elicit native cardiac sinus rhythm. Videoscopy, fluoroscopy, ultrasound, and infrared imaging were performed for anatomical and experimental study. RESULTS Systolic and diastolic left ventricular pressures observed for human and swine specimens were 68/2 ± 11/7 and 74/3 ± 17/5 mmHg, respectively, with associated native heart rates of 80 ± 7 and 96 ± 16 beats per minute. High-resolution imaging within functioning human pulmonary vasculature was obtained among other anatomies of interest. Note that one human specimen elicited poor cardiac performance post defibrillation. CONCLUSIONS We report the first dynamic videoscopic images of the pulmonary vasculature during viable cardiopulmonary function in isolated reanimated heart-lung blocs. This experimental approach provides unique in vitro opportunities for the study of novel medical therapeutics applied to large mammalian, including human, heart-lung specimens.
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Affiliation(s)
- Ryan P Goff
- Departments of Biomedical Engineering, University of Minnesota, 420 Delaware St. SE, B172 Mayo, Minneapolis, MN, 55455, USA.,Departments of Surgery, University of Minnesota, 420 Delaware St. SE, B172 Mayo, Minneapolis, MN, 55455, USA
| | - Brian T Howard
- Departments of Biomedical Engineering, University of Minnesota, 420 Delaware St. SE, B172 Mayo, Minneapolis, MN, 55455, USA.,Departments of Surgery, University of Minnesota, 420 Delaware St. SE, B172 Mayo, Minneapolis, MN, 55455, USA
| | - Stephen G Quallich
- Departments of Biomedical Engineering, University of Minnesota, 420 Delaware St. SE, B172 Mayo, Minneapolis, MN, 55455, USA.,Departments of Surgery, University of Minnesota, 420 Delaware St. SE, B172 Mayo, Minneapolis, MN, 55455, USA
| | - Tinen L Iles
- Departments of Surgery, University of Minnesota, 420 Delaware St. SE, B172 Mayo, Minneapolis, MN, 55455, USA
| | - Paul A Iaizzo
- Departments of Surgery, University of Minnesota, 420 Delaware St. SE, B172 Mayo, Minneapolis, MN, 55455, USA.
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Granegger M, Aigner P, Haberl T, Mahr S, Tamez DA, Graham J, Nunez NJ, Schima H, Moscato F. Interaction of a Transapical Miniaturized Ventricular Assist Device With the Left Ventricle: Hemodynamic Evaluation and Visualization in an Isolated Heart Setup. Artif Organs 2016; 40:1113-1120. [PMID: 27230977 DOI: 10.1111/aor.12730] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 11/26/2022]
Abstract
New left ventricular assist devices (LVADs) offer both important advantages and potential hazards. VAD development requires better and expeditious ways to identify these advantages and hazards. We validated in an isolated working heart the hemodynamic performance of an intraventricular LVAD and investigated how its outflow cannula interacted with the aortic valve. Hearts from six pigs were explanted and connected to an isolated working heart setup. A miniaturized LVAD was implanted within the left ventricle (tMVAD, HeartWare Inc., Miami Lakes, FL, USA). In four experiments blood was used to investigate hemodynamics under various loading conditions. In two experiments crystalloid perfusate was used, allowing visualization of the outflow cannula within the aortic valve. In all hearts the transapical miniaturized ventricular assist device (tMVAD) implantation was successful. In the blood experiments hemodynamics similar to those observed clinically were achieved. Pump speeds ranged from 9 to 22 krpm with a maximum of 7.6 L/min against a pressure difference between ventricle and aorta of ∼50 mm Hg. With crystalloid perfusate, central positioning of the outflow cannula in the aortic root was observed during full and partial support. With decreasing aortic pressures the cannula tended to drift toward the aortic root wall. The tMVAD could unload the ventricle similarly to LVADs under conventional cannulation. Aortic pressure influenced central positioning of the outflow cannula in the aortic root. The isolated heart is a simple, accessible evaluation platform unaffected by complex reactions within a whole, living animal. This platform allowed detection and visualization of potential hazards.
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Affiliation(s)
- Marcus Granegger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna.,Ludwig Boltzmann Cluster for Cardiovascular Research
| | - Philipp Aigner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna.,Ludwig Boltzmann Cluster for Cardiovascular Research
| | - Thomas Haberl
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephane Mahr
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Heinrich Schima
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna.,Ludwig Boltzmann Cluster for Cardiovascular Research.,Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna.,Ludwig Boltzmann Cluster for Cardiovascular Research
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Schmidt MM, Franz MR, Laske TG, Stewart MT, Iaizzo PA. In Vitro Evaluations of Cardiac Mapping Catheters Designs and Utilities: Employing Visible Heart® Methodologies1. J Med Device 2016. [DOI: 10.1115/1.4033150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Megan M. Schmidt
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455
| | - Michael R. Franz
- Cardiology Division, Veteran Affairs and Georgetown University Medical Center, Washington, DC 20007
| | - Timothy G. Laske
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455
- Medtronic LLC, Mounds View, MN 55112
| | | | - Paul A. Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455
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42
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Seewald M, Coles JA, Sigg DC, Iaizzo PA. Featured Article: Pharmacological postconditioning with delta opioid attenuates myocardial reperfusion injury in isolated porcine hearts. Exp Biol Med (Maywood) 2016; 242:986-995. [PMID: 28440739 DOI: 10.1177/1535370216684041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Ischemic preconditioning has been utilized to protect the heart from ischemia prior to ischemia onset, whereas postconditioning is employed to minimize the consequences of ischemia at the onset of reperfusion. The underlying mechanisms and pathways of ischemic pre- and postconditioning continue to be investigated as therapeutic targets. We evaluated the administration of a delta opioid agonist or cariporide on various parameters associated with myocardial reperfusion injury upon reperfusion of isolated porcine hearts. The hearts were reperfused in vitro with a Krebs buffer containing either: (1) 1 µM Deltorphin D (delta opioid specific agonist, n = 6); (2) 3 µM cariporide (sodium-hydrogen exchange inhibitor, n = 4); or (3) no treatment (control, n = 6). Subsequently, postischemic hemodynamic performance, arrhythmia burden, relative tissue perfusion, and development of necrosis were assessed over a 2 h reperfusion period. Postconditioning with Deltorphin D significantly improved diastolic relaxation (Tau, P < 0.05 versus controls) and decreased the incidence of ventricular arrhythmias during early reperfusion. Additionally, these treated hearts demonstrated increased tissue perfusion after 2 h ( P < 0.05 versus controls), suggesting improved microvascular function. Delta opioid agonists elicited the potential to attenuate reperfusion injury, suggesting a postconditioning effect of these agents. We hypothesize that the induced benefits of delta opioids, in part, are associated with decreased calcium influx on reperfusion, independent of sodium-hydrogen exchange inhibition. Such agents may have a potential role in minimizing reperfusion injury associated with coronary stenting, bypass surgery, myocardial infarction, cardiac transplantation, or with the utilization of heart preservation systems. Impact statement In this study, we found that postconditioning with Deltorphin D significantly improved diastolic relaxation and decreased the incidence of ventricular arrhythmias during early reperfusion. Furthermore, these treated hearts demonstrated increased tissue perfusion after 2 h, suggesting improved microvascular function. Delta opioid agonists attenuated reperfusion injury, suggestive of a postconditioning effect. Such agents may have a potential role in minimizing reperfusion injury associated with coronary stenting, bypass surgery, myocardial infarction, cardiac transplantation, or with the utilization of heart preservation systems.
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Affiliation(s)
- Maria Seewald
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - James A Coles
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.,2 Medtronic, Cardiac Rhythm and Heart Failure, Minneapolis, MN 55112, USA
| | - Daniel C Sigg
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.,3 FocusStart LLC, Minneapolis, MN 55413, USA
| | - Paul A Iaizzo
- 1 Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.,4 Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
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43
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Quallich SG, Goff RP, Iaizzo PA. Direct visualization of induced steam pops during radiofrequency ablation. HeartRhythm Case Rep 2015; 1:264-265. [PMID: 28491564 PMCID: PMC5419327 DOI: 10.1016/j.hrcr.2015.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Ryan P Goff
- Departments of Biomedical Engineering.,Surgery
| | - Paul A Iaizzo
- Departments of Biomedical Engineering.,Surgery.,Integrative Biology and Physiology.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
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44
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Isolated heart models: cardiovascular system studies and technological advances. Med Biol Eng Comput 2015; 53:669-78. [DOI: 10.1007/s11517-015-1270-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 03/02/2015] [Indexed: 01/27/2023]
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45
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Leopaldi AM, Vismara R, van Tuijl S, Redaelli A, van de Vosse FN, Fiore GB, Rutten MCM. A novel passive left heart platform for device testing and research. Med Eng Phys 2015; 37:361-6. [PMID: 25666402 DOI: 10.1016/j.medengphy.2015.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 11/17/2014] [Accepted: 01/17/2015] [Indexed: 10/24/2022]
Abstract
Integration of biological samples into in vitro mock loops is fundamental to simulate real device's operating conditions. We developed an in vitro platform capable of simulating the pumping function of the heart through the external pressurization of the ventricle. The system consists of a fluid-filled chamber, in which the ventricles are housed and sealed to exclude the atria from external loads. The chamber is connected to a pump that drives the motion of the ventricular walls. The aorta is connected to a systemic impedance simulator, and the left atrium to an adjustable preload. The platform reproduced physiologic hemodynamics, i.e. aortic pressures of 120/80 mmHg with 5 L/min of cardiac output, and allowed for intracardiac endoscopy. A pilot study with a left ventricular assist device (LVAD) was also performed. The LVAD was connected to the heart to investigate aortic valve functioning at different levels of support. Results were consistent with the literature, and high speed video recordings of the aortic valve allowed for the visualization of the transition between a fully opening valve and a permanently closed configuration. In conclusion, the system showed to be an effective tool for the hemodynamic assessment of devices, the simulation of surgical or transcatheter procedures and for visualization studies.
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Affiliation(s)
- A M Leopaldi
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy; LifeTec Group, Cardiovascular Department, Eindhoven, The Netherlands.
| | - R Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - S van Tuijl
- LifeTec Group, Cardiovascular Department, Eindhoven, The Netherlands
| | - A Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - F N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - G B Fiore
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - M C M Rutten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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46
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Benscoter MA, Iaizzo PA. Assessing the Relative Integrity of Formed Cardiac Linear Lesions by Recording Both Focal Monophasic Action Potentials and Contact Forces: A Technical Brief. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2015; 3:1900606. [PMID: 27170896 PMCID: PMC4848049 DOI: 10.1109/jtehm.2015.2473856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/14/2015] [Accepted: 08/20/2015] [Indexed: 11/09/2022]
Abstract
The use of therapeutic ablation in patients with atrial fibrillation has become a mainstay in the treatment of this disease, yet often these individuals require multiple procedures. In other words, successful first time treatments are impacted by challenges, including the generation of linear lesions in certain anatomies like the mitral isthmus of the left atrium. Hence, there is a need to find ways to address the presence of unwanted conduction gaps at the time of lesion creation. In this paper, we describe a novel approach to examine conduction gaps, by using a proof of concept device to examine local electrical activation within the cardiac areas of an applied lesion, i.e., to locate gaps in the lesion set. To accomplish this, both epicardial and endocardial linear ablation lines composed of spot lesions with conduction gaps were created in a porcine model. The forces necessary to elicit monophasic action potentials (MAP) were collected from >200 measurements on the epicardium of the right ventricle. Ablations were then performed on the ventricular epicardium and left atrial mitral isthmus endocardially, while recording MAPs. We were able to successfully demonstrate the use of a proof of concept device to identify conduction gaps in linear lesion sets; furthermore, we were able to determine required contact forces to appropriately determine focal electrical changes of the underlying tissues. New catheter designs that incorporate capabilities to record focal MAPs could be employed clinically to better assess a given lesion quality and/or to determine the existence of an undesired conduction gap.
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A new ex vivo beating heart model to investigate the application of heart valve performance tools with a high-speed camera. ASAIO J 2014; 60:38-43. [PMID: 24270227 DOI: 10.1097/mat.0000000000000008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
High-speed camera examination of heart valves is an established technique to examine heart valve prosthesis. The aim of this study was to examine the possibility to transmit new tools for high-speed camera examination of heart valve behavior under near-physiological conditions in a porcine ex vivo beating heart model. After explantation of the piglet heart, main coronary arteries were cannulated and the heart was reperfused with the previously collected donor blood. When the heart started beating in sinus rhythm again, the motion of the aortic and mitral valve was recorded using a digital high-speed camera system (recording rate 2,000 frames/sec). The image sequences of the mitral valve were analyzed, and digital kymograms were calculated at different angles for the exact analysis of the different closure phases. The image sequence of the aortic valve was analyzed, and several snakes were performed to analyze the effective orifice area over the time. Both processing tools were successfully applied to examine heart valves in this ex vivo beating heart model. We were able to investigate the exact open and closure time of the mitral valve, as well as the projected effective orifice area of the aortic valve over the time. The high-speed camera investigation in an ex vivo beating heart model of heart valve behavior is feasible and also reasonable because of using processing feature such as kymography for exact analysis. These analytical techniques might help to optimize reconstructive surgery of the mitral valve and the development of heart valve prostheses in future.
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48
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Quallich SG, Goff RP, Iaizzo PA. High-Speed Visualization of Steam Pops During Radiofrequency Ablation1. J Med Device 2014. [DOI: 10.1115/1.4027002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Stephen G. Quallich
- Departments of Biomedical
Engineering and Surgery, University of Minnesota, B172 Mayo, MMC 195, 420 Delaware Street S.E., Minneapolis, MN 55455
| | - Ryan P. Goff
- Departments of Biomedical
Engineering and Surgery, University of Minnesota, B172 Mayo, MMC 195, 420 Delaware Street S.E., Minneapolis, MN 55455
| | - Paul A. Iaizzo
- Departments of Biomedical
Engineering and Surgery, University of Minnesota, B172 Mayo, MMC 195, 420 Delaware Street S.E., Minneapolis, MN 55455
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49
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Bateman MG, Iaizzo PA. Imaging in the context of replacement heart valve development: use of the Visible Heart(®) methodologies. Cardiovasc Diagn Ther 2013; 2:220-30. [PMID: 24282719 DOI: 10.3978/j.issn.2223-3652.2012.07.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 07/02/2012] [Indexed: 11/14/2022]
Abstract
In recent years huge strides have been made in the fields of interventional cardiology and cardiac surgery which now allow physicians and surgeons to repair or replace cardiac valves with greater success in a larger demographic of patients. Pivotal to these advances has been significant improvements in cardiac imaging and improved fundamental understanding of valvular anatomies and morphologies. We describe here a novel series of techniques utilized within the Visible Heart(®) laboratory by engineers, scientists, and/or anatomists to visualize and analyze the form and function of the four cardiac valves and to assess potential repair or replacement therapies. The study of reanimated large mammalian hearts (including human hearts) using various imaging modalities, as well as specially prepared anatomical specimens, has enhanced the design, development, and testing of novel cardiac therapies.
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Affiliation(s)
- Michael G Bateman
- Department of Surgery and the Institute for Engineering in Medicine at the University of Minnesota, Minneapolis, MN 55455, USA
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50
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Spencer JH, Quill JL, Bateman MG, Eggen MD, Howard SA, Goff RP, Howard BT, Quallich SG, Iaizzo PA. The benefits of the Atlas of Human Cardiac Anatomy website for the design of cardiac devices. Expert Rev Med Devices 2013; 10:729-34. [PMID: 24195457 DOI: 10.1586/17434440.2013.843449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper describes how the Atlas of Human Cardiac Anatomy website can be used to improve cardiac device design throughout the process of development. The Atlas is a free-access website featuring novel images of both functional and fixed human cardiac anatomy from over 250 human heart specimens. This website provides numerous educational tutorials on anatomy, physiology and various imaging modalities. For instance, the 'device tutorial' provides examples of devices that were either present at the time of in vitro reanimation or were subsequently delivered, including leads, catheters, valves, annuloplasty rings and stents. Another section of the website displays 3D models of the vasculature, blood volumes and/or tissue volumes reconstructed from computed tomography and magnetic resonance images of various heart specimens. The website shares library images, video clips and computed tomography and MRI DICOM files in honor of the generous gifts received from donors and their families.
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Affiliation(s)
- Julianne H Spencer
- University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, USA
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