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Takada J, Morimura H, Hamada K, Okamoto Y, Mineta S, Tsuboko Y, Hattori K, Iwasaki K. A tissue-silicone integrated simulator for right ventricular pulsatile circulation with severe functional tricuspid regurgitation. Sci Rep 2024; 14:5120. [PMID: 38429438 PMCID: PMC10907752 DOI: 10.1038/s41598-024-55058-w] [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: 10/31/2022] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
There is a great demand for development of a functional tricuspid regurgitation (FTR) model for accelerating development and preclinical study of tricuspid interventional repair devices. This study aimed to develop a severe FTR model by creating a tissue-silicone integrated right ventricular pulsatile circulatory simulator. The simulator incorporates the porcine tricuspid annulus, valve leaflets, chordae tendineae, papillary muscles, and right ventricular wall as one continuous piece of tissue, thereby preserving essential anatomical relationships of the tricuspid valve (TV) complex. We dilated the TV annulus with collagenolytic enzymes under applying stepwise dilation, and successfully achieved a severe FTR model with a regurgitant volume of 45 ± 9 mL/beat and a flow jet area of 15.8 ± 2.3 cm2 (n = 6). Compared to a normal model, the severe FTR model exhibited a larger annular circumference (133.1 ± 8.2 mm vs. 115.7 ± 5.5 mm; p = 0.009) and lower coaptation height (6.6 ± 1.0 mm vs. 17.7 ± 1.3 mm; p = 0.003). Following the De-Vega annular augmentation procedure to the severe FTR model, a significant reduction in regurgitant volume and flow jet area were observed. This severe FTR model may open new avenues for the development and evaluation of transcatheter TV devices.
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Affiliation(s)
- Jumpei Takada
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, Japan
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
| | - Hayato Morimura
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, Tokyo, Japan
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
| | - Kohei Hamada
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
| | - Yusei Okamoto
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Shiho Mineta
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
| | - Yusuke Tsuboko
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
| | - Kaoru Hattori
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
- Institute for Medical Regulatory Science, Waseda University, Tokyo, Japan
| | - Kiyotaka Iwasaki
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, Japan.
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan.
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, Tokyo, Japan.
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, Japan.
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan.
- Institute for Medical Regulatory Science, Waseda University, Tokyo, Japan.
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Werner P, Poschner T, Gross C, Russo M, Laufer G, Sauer J, Andreas M. Evaluation of a Novel Automated Suturing Technology for Mitral Chordal Implantation: 1-Year Results. Ann Thorac Surg 2024; 117:474-478. [PMID: 37890817 DOI: 10.1016/j.athoracsur.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE A new automated expanded polytetrafluoroethylene (ePTFE) suture placement device and a new customized titanium fastener deployment device were clinically evaluated in open and less-invasive mitral valve repair (MVr). DESCRIPTION Twelve patients were monitored for 1 year after undergoing MVr using the study devices. The study end points included surgical outcomes, operative times, valve repair durability, adverse events, and mortality. EVALUATION Three patients received 1 ePTFE chord using the study technology, and 9 patients received 2 chords. Mitral regurgitation at 30 days was absent in 8 patients, trace in 2, and mild in 2. At the 1-year follow-up, mitral regurgitation was absent in 7 patients, trace in 2, mild in 2, and moderate in 1. There were no replacement chord failures, reoperations, or death. CONCLUSIONS The initial outcomes of new automated ePTFE suture placement and titanium fastener deployment devices encourage further clinical evaluations.
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Affiliation(s)
- Paul Werner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
| | - Thomas Poschner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Gross
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Russo
- Cardiothoracic & Vascular Department, San Camillo Forlanini Hospital of Rome, Rome, Italy
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Jude Sauer
- Department of Surgery, University of Rochester Medical Center, Rochester, New York; LSI SOLUTIONS, Victor, New York
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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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.
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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
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Werner P, Rath C, Gross C, Ad N, Gosev I, Amirjamshidi H, Poschner T, Coti I, Russo M, Mach M, Kocher A, Laufer G, Sauer J, Andreas M. Novel Automated Suturing Technology for Minimally Invasive Mitral Chord Implantation: A Preclinical Evaluation Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:506-512. [PMID: 36447382 PMCID: PMC9846373 DOI: 10.1177/15569845221133381] [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] [Indexed: 12/05/2022]
Abstract
OBJECTIVE This study evaluated the ergonomics and time requirements of using a novel automated suturing and titanium fastener deployment technology for chordal replacement in human heart specimens in open and minimally invasive cardiac surgery (MICS) simulators. METHODS Five cardiac surgeons used novel, manually powered expanded polytetrafluoroethylene (ePTFE) suturing devices to automate suture placement between mitral leaflets and papillary muscles in explanted cadaver hearts, along with customized titanium fastener delivery devices to secure suture and trim suture tails. This mitral chordal replacement test was conducted using surgical models simulating open and MICS mitral repair access. The study was approved by the institutional ethical board. RESULTS After a brief introduction to this technique using plastic models, study surgeons performed 48 chordal replacements in human mitral valves, placing 18 in an open model and 30 in a right minithoracotomy model. The time range to complete a single chordal replacement was between 55 s and 8 min, with an overall mean duration of 3.6 ± 1.5 min. No difference in duration of implantation was recorded for the MICS and open sternotomy simulators used. Good control of suture delivery was reported in 95.8% (n = 46) of leaflet aspect of the sutures and in 100% (N = 48) of papillary muscle sutures. CONCLUSIONS Automated mitral chordal ePTFE suturing simulated through open and MICS access demonstrated quality handling and accurate placement of sutures in human heart specimens. A clinical trial using this technology is currently ongoing. This innovation may present an important advance facilitating enhanced minimally invasive mitral valve repair.
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Affiliation(s)
- Paul Werner
- Department of Cardiac Surgery, Medical
University of Vienna, Austria,Paul Werner, MD, Department of Cardiac
Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090,
Austria.
| | - Claus Rath
- Department of Cardiac Surgery, Medical
University of Vienna, Austria
| | - Christoph Gross
- Department of Cardiac Surgery, Medical
University of Vienna, Austria
| | - Niv Ad
- Department of Surgery, University of
Maryland School of Medicine, Baltimore, MD, USA
| | - Igor Gosev
- Department of Surgery, Medical
University of Rochester, NY, USA
| | | | - Thomas Poschner
- Department of Cardiac Surgery, Medical
University of Vienna, Austria
| | | | - Marco Russo
- San Camillo Forlanini Hospital of Rome,
Italy
| | - Markus Mach
- Department of Cardiac Surgery, Medical
University of Vienna, Austria
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical
University of Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical
University of Vienna, Austria
| | - Jude Sauer
- Department of Surgery, Medical
University of Rochester, NY, USA
| | - Martin Andreas
- Department of Cardiac Surgery, Medical
University of Vienna, Austria
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Russo M, Di Mauro M, Saitto G, Lio A, Berretta P, Taramasso M, Scrofani R, Della Corte A, Sponga S, Greco E, Saccocci M, Calafiore A, Bianchi G, Leviner DB, Biondi A, Della Ratta E, Livi U, Sharoni E, Werner P, De Vincentiis C, Di Eusanio M, Kocher A, Antona C, Miraldi F, Troise G, Solinas M, Maisano F, Laufer G, Musumeci F, Andreas M. Beating vs Arrested Heart Isolated Tricuspid Valve Surgery: Long-term Outcomes. Ann Thorac Surg 2021; 113:585-592. [PMID: 33831392 DOI: 10.1016/j.athoracsur.2021.03.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/22/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Isolated tricuspid valve (TV) surgery is a rare procedure generally considered at high risk of perioperative mortality and poor long-term outcomes. Surgical treatment can be performed with either an arrested heart (AH) or beating heart (BH) technique. Aim of this study is to compare the outcomes of isolated tricuspid surgery with two different approaches. METHODS The SUR-TRI study is a multicenter international retrospective study enrolling adult patients who underwent isolated tricuspid valve procedures (n=406, 56±16 years; 56% female) at 13 international sites. AH and BH strategies were performed in 253 and 153 cases, respectively. Propensity score-matched analysis was used to compare groups. RESULTS After matching, 129 pairs were obtained and analyzed. The 30-day mortality rate was 6.2 vs 5.0% in the AH and BH groups, respectively (p=0.9). The rates of acute renal failure requiring replacement therapy (3 vs 10%, p=0.02) and stroke (0 vs 1.8%, p=0.08) were numerically higher in the AH group. The 6-year survival rate was 67±6 vs 78±5% in the AH and BH groups, respectively (p=0.18), while freedom from cardiac death was 75±5 vs 84±4% (p=0.21). The six-year composite cardiac endpoint of cardiac death and reoperation rate was 60±9 vs 86±5% (p=0.024) comparing AH-TV replacement and BH-TV repair groups. CONCLUSIONS Isolated tricuspid valve surgery performed with a beating heart strategy is a safe option and resulted in a trend of increased long-term survival and freedom from reoperation when compared with the standard arrested heart technique. Patients undergoing beating heart valve repair had the best long-term outcome.
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Affiliation(s)
- Marco Russo
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy.
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Guglielmo Saitto
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy; Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Antonio Lio
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy; Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Heart Center of Zurich, Zurich, Switzerland
| | - Roberto Scrofani
- Cardiac Surgery Unit, Ospedale Fatenefratelli Sacco, Milano, Italy
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli," Unit of Cardiac Surgery, V Monaldi Hospital, Neaples, Italy
| | - Sandro Sponga
- Cardiac Surgery Unit, University Hospital of Udine, Udine, Italy
| | - Ernesto Greco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Matteo Saccocci
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Giacomo Bianchi
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | | | - Andrea Biondi
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Ester Della Ratta
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli," Unit of Cardiac Surgery, V Monaldi Hospital, Neaples, Italy
| | - Ugolino Livi
- Cardiac Surgery Unit, University Hospital of Udine, Udine, Italy
| | | | - Paul Werner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlo Antona
- Cardiac Surgery Unit, Ospedale Fatenefratelli Sacco, Milano, Italy
| | - Fabio Miraldi
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Solinas
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Francesco Maisano
- Cardiac Surgery Department, University Heart Center of Zurich, Zurich, Switzerland
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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