1
|
Jaworek M, Gelpi G, Perico F, Romagnoni C, Tasca G, Salurso E, Contino M, Redaelli A, Fiore GB, Vismara R. Coronary Perfusion After Valve-in-Valve Transcatheter Aortic Valve Implantation in Small Aortic Root: In Vitro Experimental Assessment. J Cardiovasc Transl Res 2023; 16:956-967. [PMID: 37097591 PMCID: PMC10480284 DOI: 10.1007/s12265-023-10364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/13/2023] [Indexed: 04/26/2023]
Abstract
Coronary flow obstruction following transcatheter aortic valve-in-valve implantation (VIV-TAVI) is associated with a high mortality risk. The aim of this work was to quantify the coronary perfusion after VIV-TAVI in a high-risk aortic root anatomy. 3D printed models of small aortic root were used to simulate the implantation of a TAVI prosthesis (Portico 23) into surgical prostheses (Trifecta 19 and 21). The aortic root models were tested in a pulsatile in vitro bench setup with a coronary perfusion simulator. The tests were performed at baseline and post-VIV-TAVI procedure in aligned and misaligned commissural configurations under simulated hemodynamic rest and exercise conditions. The experimental design provided highly controllable and repeatable flow and pressure conditions. The left and right coronary mean flow did not differ significantly at pre- and post-VIV-TAVI procedure in any tested configurations. The commissural misalignment did not induce any significant alterations to the coronary flow. High-risk aortic root anatomy did not trigger coronary ostia obstruction or coronary flow alteration after transcatheter aortic valve implantation in a surgical bioprosthesis as shown from in-vitro flow loop tests.
Collapse
Affiliation(s)
- Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Guido Gelpi
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Perico
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Claudia Romagnoni
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Giordano Tasca
- Cardiac Surgery Department, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Eleonora Salurso
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Monica Contino
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Gianfranco Beniamino Fiore
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133 Milan, Italy
- ForcardioLab—Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| |
Collapse
|
2
|
Salurso E, Jaworek M, Perico F, Frigelli M, Romagnoni C, Contino M, Gelpi G, Fiore GB, Vismara R. Morphometric Characterization of an Ex Vivo Porcine Model of Functional Tricuspid Regurgitation. Ann Biomed Eng 2023; 51:715-725. [PMID: 36151505 PMCID: PMC10023622 DOI: 10.1007/s10439-022-03080-2] [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] [Received: 04/12/2022] [Accepted: 09/07/2022] [Indexed: 11/01/2022]
Abstract
Emerging treatments for tricuspid valve (TV) regurgitation require realistic TV pathological models for preclinical testing. The aim of this work was to investigate structural features of fresh and defrosted porcine right-heart samples as models of mild and severe functional tricuspid regurgitation (FTR) condition in ex-vivo pulsatile flow platform. Ten fresh hearts were tested ex-vivo under steady and pulsatile flow in typical right-heart loading conditions. Hemodynamics and 3D echocardiographic imaging of TV and right ventricle (RV) were acquired. Hearts were then kept frozen for 14 days, defrosted, and tested again with the same protocol. Morphometric parameters of TV and RV were derived from 3D reconstructions based on echo data. Fresh samples showed a slightly dilated TV morphology, with coaptation gaps among the leaflets. Sample freezing induced worsening of TV insufficiency, with significant (p < 0.05) increases in annulus size (annulus area and perimeter 7.7-3.1% respectively) and dilation of RV (9.5%), which led to an increase in tenting volume (123.7%). These morphologic alterations reflected into a significant increment of regurgitation fraction (27%). Together, such results suggest that fresh porcine heart samples may be a reliable ex-vivo model of mild FTR condition, which can be enhanced through freezing/thawing treatment to model a severe pathological condition.
Collapse
Affiliation(s)
- Eleonora Salurso
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.
| | - Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Francesca Perico
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Matteo Frigelli
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Claudia Romagnoni
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiovascular Surgery Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Monica Contino
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiovascular Surgery Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Guido Gelpi
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiovascular Surgery Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Gianfranco Beniamino Fiore
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| |
Collapse
|
3
|
Jaworek M, Mangini A, Maroncelli E, Lucherini F, Rosa R, Salurso E, Votta E, Antona C, Fiore GB, Vismara R. Ex Vivo Model of Functional Mitral Regurgitation Using Deer Hearts. J Cardiovasc Transl Res 2020; 14:513-524. [PMID: 32959169 PMCID: PMC8219575 DOI: 10.1007/s12265-020-10071-y] [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: 03/19/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022]
Abstract
Transcatheter therapies are emerging for functional mitral regurgitation (FMR) treatment, however there is lack of pathological models for their preclinical assessment. We investigated the applicability of deer hearts for this purpose. 8 whole deer hearts were housed in a pulsatile flow bench. At baseline, all mitral valves featured normal coaptation. The pathological state was induced by 60-minutes intraventricular constant pressurization. It caused mitral annulus dilation (antero-posterior diameter increase from 31.8 ± 5.6 mm to 39.5 ± 4.9 mm, p = 0.001), leaflets tethering (maximal tenting height increase from 7.3 ± 2.5 mm to 12.7 ± 3.4 mm, p < 0.001) and left ventricular diameter increase (from 67.8 ± 7.5 mm to 79.4 ± 6.5 mm, p = 0.004). These geometrical reconfigurations led to restricted mitral valve leaflets motion and leaflet coaptation loss. Preliminary feasibility assessment of two FMR treatments was performed in the developed model. Deer hearts showed ability to dilate under constant pressurization and have potential to be used for realistic preclinical research of novel FMR therapies. Graphical abstract figure legend: Deer heart mitral valve fiberscopic and echocardiographic images in peak systole at baseline and after inducing the pathological conditions representing functional mitral regurgitation. In the pathological conditions lack of coaptation between the leaflets, enlargement of the antero-posterior distance (red dashed line) and the left ventricular diameter (orange dashed line) were observed. ![]()
Collapse
Affiliation(s)
- Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy. .,ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.
| | - Andrea Mangini
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.,Cardiovascular Surgery Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy
| | - Edoardo Maroncelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy
| | - Federico Lucherini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.,ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Rubina Rosa
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.,Cardiovascular Surgery Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy
| | - Eleonora Salurso
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.,3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Carlo Antona
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.,Cardiovascular Surgery Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Gianfranco Beniamino Fiore
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.,ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.,ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| |
Collapse
|
4
|
Sulejmani F, Pataky J, Sun W. Mechanical and Structural Evaluation of Tricuspid Bicuspidization in a Porcine Model. Cardiovasc Eng Technol 2020; 11:522-531. [PMID: 32737819 DOI: 10.1007/s13239-020-00480-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 07/22/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Tricuspid regurgitation (TR) affects approximately 1.6 million Americans and is associated with just a 63.9% 1-year survival rate in its moderate to severe forms due to its asymptomatic nature and late diagnosis and surgical referral. As a result, industrial fervor has begun to broach this topic, with several percutaneous treatment devices currently under development. As much remains unknown about the tricuspid apparatus, the mechanics of these procedures remain unquantified. In this study, a testing apparatus and technique for the evaluation of percutaneous tricuspid valve (TV) bicuspidization were developed for the evaluation of these parameters in twelve porcine hearts. METHODS The passive relaxed myocardial state and the active contracted state were each induced in six porcine hearts and the bicuspidization experiment was run twice, the second time after induction of TR. TV annular area, cinching force, static leakage through the TV annulus, and annular ellipticity were quantified and compared among the groups. RESULTS The use of phenol was effective to induce functional TR by increased annular area. Cinching force was not found to differ between any of the testing states, but the bicuspidization experiment was able to reduce the TR annular area to that of its healthy counterpart in addition to reducing static leakage through the TV annulus. Despite appropriately reducing the area, bicuspidization was found to induce a more circular TV annular shape. CONCLUSION Taken together, these results provide a first mechanical analysis of the TV bicuspidization mechanism and may serve as a point of reference for future clinical animal studies.
Collapse
Affiliation(s)
- Fatiesa Sulejmani
- Tissue Mechanics Laboratory, The Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 206 Technology Enterprise Park, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Joshua Pataky
- Tissue Mechanics Laboratory, The Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 206 Technology Enterprise Park, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 206 Technology Enterprise Park, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
| |
Collapse
|
5
|
Jaworek M, Pappalardo OA, Selmi M, Gelpi G, Romagnoni C, Lucherini F, Ajmone-Marsan N, Redaelli A, Fiore GB, Votta E, Antona C, Vismara R. Treatment of Tricuspid Regurgitation at Subvalvular Level: Hemodynamic and Morphological Assessment in Ex-Vivo Beating Heart Model. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1686555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- ForcardioLab – Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Omar A. Pappalardo
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Matteo Selmi
- Division of Cardiac Surgery, Department of Surgery, Università di Verona, Verona, Italy
| | - Guido Gelpi
- ForcardioLab – Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiovascular Surgery Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy
| | - Claudia Romagnoni
- ForcardioLab – Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiovascular Surgery Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy
| | - Federico Lucherini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- ForcardioLab – Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Nina Ajmone-Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Gianfranco B. Fiore
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- ForcardioLab – Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Carlo Antona
- ForcardioLab – Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiovascular Surgery Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- ForcardioLab – Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| |
Collapse
|