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Novel In Vitro Test Systems and Insights for Transcatheter Mitral Valve Design, Part I: Paravalvular Leakage

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Abstract

While transcatheter mitral valve (TMV) replacement technology has great clinical potential for surgically inoperable patients suffering from mitral regurgitation, no TMV has yet achieved regulatory approval. The diversity of devices currently under development reflects a lack of consensus regarding optimal design approaches. In Part I of this two-part study, a test system was developed for the quantification of paravalvular leakage (PVL) following deployment of a TMV or TMV-like device in pressurized, explanted porcine hearts (N = 7). Using this system, PVL rate was investigated as a function of steady trans-mitral pressure (ΔP), TMV shape, and TMV-annular oversizing, using a series of “mock TMV plug” devices. Across all devices, PVL was found to approximately trend with the square of ΔP. PVL rates were approximately 0–15 mL/s under hypotensive pressure, 10–40 mL/s under normotension, and 30–85 mL/s under severe hypertension. D-shaped devices significantly reduced PVL vs. circular devices; however, this effect was diminished upon oversizing to the annulus by 6 mm inter-trigonal distance. In conclusion, this steady pressure, in vitro test system was effective to compare PVL performance across TMV-like designs. PVL exhibited complex dynamics in terms of its response to transvalvular pressure and TMV profile.

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Abbreviations

C:

Circular

D:

D-shaped

GLM:

General Linear Model

IC:

Inter-commissural

MV:

Mitral valve

MR:

Mitral regurgitation

LVP:

Left ventricular pressure

PVL:

Paravalvular leakage

SL:

Septal-lateral

TAVR:

Transcatheter aortic valve replacement

TMV:

Transcatheter mitral valve

TMVR:

Transcatheter mitral valve replacement

ΔP :

Trans-mitral pressure gradient

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Acknowledgments

This study was supported by a grant from the National Science Foundation (DGE-1148903; ELP), and by the National Heart, Lung, and Blood Institute (R01HL113216). The authors thank Charles Bloodworth and Dr. Joseph Gorman for study design contributions, and Holifield Farms, Covington, GA, for donating porcine hearts.

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Authors and Affiliations

  1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313, USA

    Eric L. Pierce, Vahid Sadri, Beatrice Ncho, Keshav Kohli, Siddhi Shah & Ajit P. Yoganathan

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  1. Eric L. Pierce
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  2. Vahid Sadri
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  3. Beatrice Ncho
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Correspondence to Ajit P. Yoganathan.

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Associate Editor Jane Grande-Allen oversaw the review of this article.

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Pierce, E.L., Sadri, V., Ncho, B. et al. Novel In Vitro Test Systems and Insights for Transcatheter Mitral Valve Design, Part I: Paravalvular Leakage. Ann Biomed Eng 47, 381–391 (2019). https://doi.org/10.1007/s10439-018-02154-4

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