Long-arm Clip for Transcatheter Edge-to-Edge Treatment of Mitral and Tricuspid Regurgitation – Ex-Vivo Beating Heart Study

Historically, the research on the right ventricle (RV) has been neglected by his left equivalent because of the complexity of left ventricle (LV) dysfunction. Tricuspid regurgitation (TR) can be classified as linked to primary valve disease or functional in nature, but most are functional. Although it was historically assumed that such functional Tricuspid regurgitation, i.e. arising from leftsided disease, and it can be resolved after corrective surgery, but after successful surgery, on the aortic or mitral valve annular dilatation, the Tricuspid regurgitation and right ventricular dysfunction may persist.To study the circumference of tricuspid orifice and it’s the diameter in two perpendicular planes and its comparison among the male and female population. The material for the present study comprised of 50 formalin fixed human hearts (35 males and 15 females) which were obtained from the department of anatomy. In this study, it is observed that: The mean value of circumference of a tricuspid orifice is 11.01+/-0.63 cm. The diameter of tricuspid orifice along the frontal dimension is 3.06+/-0.38 cm, and the diameter along the sagittal dimension is 2.26+/-0.23 cm. The measurements of the circumference of tricuspid orifice reported for males and females in western countries were higher than the present study and the diameter along the frontal dimension is greater than the diameter along the sagittal dimension. The tricuspid valve diameter along the frontal dimension was more than the diameter along the sagittal dimension in both males and females.

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GW26-e3579 Feasible and Controllable Creation of Tricuspid Regurgitation Beagle Dog Model from Tricuspid Leaflet Resection in open beating heart

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.06.400 ◽

2015 ◽

Vol 66 (16) ◽

pp. C103

Author(s):

Xujing Xie ◽

Huanlei Huang

Keyword(s):

Tricuspid Regurgitation ◽

Beating Heart ◽

Beagle Dog ◽

Dog Model

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Abstract 16979: Hemodynamic Comparison of Tricuspid Ring Annuloplasty vs. Hetzer Annuloplasty Technique to Repair Functional Tricuspid Regurgitation

Circulation ◽

10.1161/circ.142.suppl_3.16979 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Alan Amedi ◽

Daisuke Onohara ◽

Muralidhar Padala

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Ex Vivo ◽

Working Fluid ◽

Posterior Leaflet ◽

Anterior Leaflet ◽

Ex Vivo Model ◽

Functional Tricuspid Regurgitation ◽

Ring Annuloplasty ◽

Valve Function

Introduction: Surgical repair of functional tricuspid regurgitation (FTR) is increasingly performed, and the techniques are evolving. Annuloplasty is currently the technique of choice, with different techniques yielding varied results, and thus require optimization. Objective: In this study, we sought to compare tricuspid valve function and kinematics after ring annuloplasty and Hetzer’s double orifice repair in an ex vivo model of FTR. Methods: Ten pig hearts were mounted into a right heart simulator, and studied at 70 bpm while maintaining the total volume of working fluid. FTR was created by increasing afterload, which caused acute right ventricular dilation and TV tethering. Tricuspid valve annuloplasty (TVA) was performed with a 26mm MC 3 ring. Hetzer procedure was performed with pledgeted sutures that approximated the anteroposterior and septal annular segments. Flow probes were used to measure FTR, and leaflet kinematics with echocardiography. Results: FTR of 17.7±9.2mL(p<0.0001) after RV dilation. Repair with TVA and Hetzer reduced FTR to 8.8±6.8ml(p=0.7142) and 7.8±6.9ml(p=0.0919), respectively, but did not eliminate it. Septal leaflet excursion angle decreased by 48.1% with FTR (p=0.04 vs. baseline ) . Repair with TVA and Hetzer increased the angle to 17.3±6.7°(p=0.0312) and 21.5±8.3°(vs FTR, p=0.0034), respectively. The Hetzer improved septal leaflet mobility better than TVA (p=0.0145). The posterior leaflet excursion angle decreased by 49.2% compared to baseline to 18.4±10.5° (p=0.0060) and both TVA and Hetzer significantly improved mobility to 33.6±8.4° (p=0.0081) and 31.6±15.6° (p=0.0256), respectively. Anterior leaflet mobility decreased after FTR by 60.7% to 18.1±8.2°. The effect of these repairs on the sub-valvular apparatus was negligible. Conclusion: TVA and Hetzer both reduced regurgitation but did not eliminate it. Septal and posterior leaflet mobility was improved, while the anterior leaflet remained tethered.

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Relationship Between Ablation Lesion Size Estimated by Ablation Index and Different Ablation Settings—an Ex Vivo Porcine Heart Study

Journal of Cardiovascular Translational Research ◽

10.1007/s12265-020-10037-0 ◽

2020 ◽

Vol 13 (6) ◽

pp. 965-969

Author(s):

Shu-Tao Huang ◽

Jian-Zeng Dong ◽

Xin Du ◽

Jia-Hui Wu ◽

Rong-Hui Yu ◽

...

Keyword(s):

Ex Vivo ◽

Lesion Size ◽

Ablation Lesion ◽

Porcine Heart ◽

Heart Study ◽

Ablation Index

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“The Balloon Plug Concept” for Tricuspid Valve Repair Ex Vivo Proof of Concept

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000124 ◽

2015 ◽

Vol 10 (1) ◽

pp. 27-32 ◽

Cited By ~ 2

Author(s):

Pietro Bajona ◽

Stefano Salizzoni ◽

Stijn Vandenberghe ◽

Charles J. Bruce ◽

Giovanni Speziali ◽

...

Keyword(s):

Tricuspid Regurgitation ◽

Ex Vivo ◽

Tricuspid Valve Repair ◽

Functional Tricuspid Regurgitation ◽

Novel Approach ◽

Annular Dilatation ◽

Transvalvular Gradient ◽

Antegrade Flow ◽

The Right

Objective Functional tricuspid regurgitation (TR) is recognized as a significant cause of morbidity and mortality in cardiothoracic surgery. We hypothesized that a variably expandable, transvalvular balloon mounted on a catheter could be percutaneously inserted and fixed to the right ventricle apex. This novel approach could provide a minimally invasive way to eliminate clinically relevant TR caused by annular dilatation. This study was performed to test the ex vivo hemodynamic effects and the feasibility of the “balloon plug concept.” Methods Twenty harvested calf tricuspid valves were placed in a mechanical simulator. Tricuspid regurgitation was created by annular stretching and displacement of the papillary muscles so as to create central TR. A flexible catheter with a 4-cm–long, soft, fusiform balloon was positioned across the valve so that the balloon was suspended centrally across the valve annular plane. After activating the mechanical ventricle, data were collected with balloon inflation volumes of saline from 5 to 20 mL. Transvalvular pressure gradients and leaflet mechanics were evaluated with incremental inflation. Results In all cases, 5-mL inflation did not significantly reduce TR and 20-mL inflation caused obstruction to antegrade flow (mean transvalvular gradient > 4 mm Hg). Inflation between 10 and 15 mL caused significant reduction in TR with acceptable transvalvular gradients (<3 mm Hg). Conclusions The balloon plug concept showed promising ex vivo hemodynamic results. In vivo investigations are warranted to evaluate percutaneous techniques, thrombogenicity, and effects of repeated balloon-leaflet contact on valve integrity.

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