Ex Vivo Model of Ischemic Mitral Regurgitation and Analysis of Adjunctive Papillary Muscle Repair

Annabel M. Imbrie-Moore, Yuanjia Zhu, Tabitha Bandy-Vizcaino, Matthew H. Park, Robert J. Wilkerson, Y. Joseph Woo

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Ischemic mitral regurgitation (IMR) is particularly challenging to repair with lasting durability due to the complex valvular and subvalvular pathologies resulting from left ventricular dysfunction. Ex vivo simulation is uniquely suited to quantitatively analyze the repair biomechanics, but advancements are needed to model the nuanced IMR disease state. Here we present a novel IMR model featuring a dilation device with precise dilatation control that preserves annular elasticity to enable accurate ex vivo analysis of surgical repair. Coupled with augmented papillary muscle head positioning, the enhanced heart simulator system successfully modeled IMR pre- and post-surgical intervention and enabled the analysis of adjunctive subvalvular papillary muscle repair to alleviate regurgitation recurrence. The model resulted in an increase in regurgitant fraction: 11.6 ± 1.7% to 36.1 ± 4.4% (p < 0.001). Adjunctive papillary muscle head fusion was analyzed relative to a simple restrictive ring annuloplasty repair and, while both repairs successfully eliminated regurgitation initially, the addition of the adjunctive subvalvular repair reduced regurgitation recurrence: 30.4 ± 5.7% vs. 12.5 ± 2.6% (p = 0.002). Ultimately, this system demonstrates the success of adjunctive papillary muscle head fusion in repairing IMR as well as provides a platform to optimize surgical techniques for increased repair durability.

Original languageEnglish
Pages (from-to)3412-3424
Number of pages13
JournalAnnals of Biomedical Engineering
Volume49
Issue number12
DOIs
StatePublished - Dec 2021
Externally publishedYes

Keywords

  • Biomechanics
  • Cardiac simulator
  • Mitral valve
  • Modeling
  • Surgical repair

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