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

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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.

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Acknowledgments

This work was supported by the National Institutes of Health (NIH R01 HL152155 and NIH R01 HL089315-01, YJW), the National Science Foundation Graduate Research Fellowship Program (DGE-1656518, AMI), a Stanford Graduate Fellowship (AMI), Thoracic Surgery Foundation Resident Research Fellowship (YZ), and the Stanford University Bio-X Initiative (TB). The authors thank the Rittenberg Family Foundation (Andy, Amy, Leon and Cindy) for their generous support of this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA

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

  2. Department of Mechanical Engineering, Stanford University, Stanford, CA, USA

    Annabel M. Imbrie-Moore, Tabitha Bandy-Vizcaino & Matthew H. Park

  3. Department of Bioengineering, Stanford University, Stanford, CA, USA

    Yuanjia Zhu & Y. Joseph Woo

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  1. Annabel M. Imbrie-Moore
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Correspondence to Y. Joseph Woo.

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Imbrie-Moore, A.M., Zhu, Y., Bandy-Vizcaino, T. et al. Ex Vivo Model of Ischemic Mitral Regurgitation and Analysis of Adjunctive Papillary Muscle Repair. Ann Biomed Eng 49, 3412–3424 (2021). https://doi.org/10.1007/s10439-021-02879-9

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