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An Animal Model of Functional Tricuspid Regurgitation by Leaflet Tethering Using Image-Guided Chordal Encircling Snares

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Abstract

Several interventional therapies are in development to treat functional tricuspid regurgitation. Most have failed to achieve adequate efficacy, as animal models of this lesion are lacking. We developed a new image-guided technique in swine, by tethering the tricuspid valve chordae using echo-guided chordal encircling snares. Five swine underwent baseline echocardiographic assessment of tricuspid valve function, followed by echo-guided placement of snares that encircle the chordae inserting into the anterior and posterior tricuspid valve leaflets. Tethering these snares and stabilizing them on the right ventricle caused the regurgitant fraction to increase from 8.48±5.38% to 48.76±12.5%, and the valve tenting area to increase from 60.26±52.19 to 160.9±86.92 mm2. Image-guided chordal encircling snares could reproducibly induce clinically significant levels of functional tricuspid regurgitation and create a valve geometry like that seen in patients, providing a new animal model for use to study novel interventional devices.

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Abbreviations

FTR:

Functional tricuspid regurgitation

SL:

Septal leaflet

AL:

Anterior leaflet

PL:

Posterior leaflet

SMPM:

Septal/medial papillary muscle

APM:

Anterior papillary muscle

IPM:

Inferior papillary muscle

TA:

Tricuspid annulus

RA:

Right atrium

RV:

Right ventricle

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Acknowledgements

The authors acknowledge veterinary technicians Amanda Maddamma and Trish Bruce for providing anesthesia support for the animal procedures. The authors also acknowledge infrastructure support from the Carlyle Fraser Heart Center at Emory University Hospital Midtown for their generous support of our lab.

Funding

This work was funded by grants from the National Institutes of Health HL135145, HL140325, HL133667, and infrastructure support from the Carlyle Fraser Heart Center at Emory University Hospital Midtown to M. Padala, when he was employed at Emory University. As of April 2023, Dr. Padala has changed his employment to be the founder and chief scientific officer of Nyra Medical. D. Onohara was supported by a grant 23CDA1053806, D. Xu was supported by grant 834086, and K. Suresh was supported by grant 915799 from the American Heart Association.

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Authors and Affiliations

  1. Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at the Emory University Hospital Midtown, Atlanta, GA, USA

    Daisuke Onohara, Michael Silverman, Kirthana Sreerangathama Suresh, Dongyang Xu, Qi He, Chase L. King & Stephanie K. Tom

  2. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Daisuke Onohara, Michael Silverman, Kirthana Sreerangathama Suresh, Dongyang Xu, Qi He, Chase L. King, Stephanie K. Tom & Kanika Kalra

  3. Nyra Medical, Inc., Decatur, GA, USA

    Muralidhar Padala

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  1. Daisuke Onohara
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Corresponding author

Correspondence to Muralidhar Padala.

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Ethics Approval

This study did not include any human subject research. Animals were used in this research, as there was no relevant alternative available. The animal study protocol, including the procedures, animal care, and endpoints, was reviewed and approved by the Institutional Animal Use and Care Committee at Emory University, and the procedures were performed according to the guidelines for the use of animals in research by the National Institutes of Health. The studies were performed at an AAALAC-accredited facility, which at all times was overseen by an attending veterinarian.

Human and Animal Rights

This study did not include any human subject’s research.

Conflict of Interest

None of the authors has any direct conflicts of interest to report that are relevant to this work. Outside this, M.Padala reports owning significant stock, employment, and board directorship at Nyra Medical, Inc, which has neither sponsored, reviewed nor had any input in this work. K. Suresh reports owning minor stock in Nyra Medical. D. Xu is currently an employee of Peijia Medical, which did not have any role in this work.

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Associate Editor Laura Iop oversaw the review of this article

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Onohara, D., Silverman, M., Suresh, K.S. et al. An Animal Model of Functional Tricuspid Regurgitation by Leaflet Tethering Using Image-Guided Chordal Encircling Snares. J. of Cardiovasc. Trans. Res. 17, 417–425 (2024). https://doi.org/10.1007/s12265-023-10424-3

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  • DOI: https://doi.org/10.1007/s12265-023-10424-3

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