A Novel Aortic Regurgitation Model from Cusp Prolapse with Hemodynamic Validation Using an Ex Vivo Left Heart Simulator

Yuanjia Zhu; Annabel M Imbrie-Moore; Michael J Paulsen; Bryant Priromprintr; Matthew H Park; Hanjay Wang; Haley J Lucian; Justin M Farry; Y Joseph Woo

doi:10.1007/s12265-020-10038-z

A Novel Aortic Regurgitation Model from Cusp Prolapse with Hemodynamic Validation Using an Ex Vivo Left Heart Simulator

J Cardiovasc Transl Res. 2021 Apr;14(2):283-289. doi: 10.1007/s12265-020-10038-z. Epub 2020 Jun 3.

Authors

Yuanjia Zhu^{1

2}, Annabel M Imbrie-Moore^{1

3}, Michael J Paulsen¹, Bryant Priromprintr⁴, Matthew H Park^{1

3}, Hanjay Wang¹, Haley J Lucian¹, Justin M Farry¹, Y Joseph Woo^{5

6

7}

Affiliations

¹ Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
² Department of Bioengineering, Stanford University, Stanford, CA, USA.
³ Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
⁴ Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA.
⁵ Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA. joswoo@stanford.edu.
⁶ Department of Bioengineering, Stanford University, Stanford, CA, USA. joswoo@stanford.edu.
⁷ Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA. joswoo@stanford.edu.

Abstract

Although ex vivo simulation is a valuable tool for surgical optimization, a disease model that mimics human aortic regurgitation (AR) from cusp prolapse is needed to accurately examine valve biomechanics. To simulate AR, four porcine aortic valves were explanted, and the commissure between the two largest leaflets was detached and re-implanted 5 mm lower to induce cusp prolapse. Four additional valves were tested in their native state as controls. All valves were tested in a heart simulator while hemodynamics, high-speed videography, and echocardiography data were collected. Our AR model successfully reproduced cusp prolapse with significant increase in regurgitant volume compared with that of the controls (23.2 ± 8.9 versus 2.8 ± 1.6 ml, p = 0.017). Hemodynamics data confirmed the simulation of physiologic disease conditions. Echocardiography and color flow mapping demonstrated the presence of mild to moderate eccentric regurgitation in our AR model. This novel AR model has enormous potential in the evaluation of valve biomechanics and surgical repair techniques. Graphical Abstract.

Keywords: Aortic regurgitation; Cusp prolapse; Left heart simulator; Porcine model.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Animals
Aortic Valve / diagnostic imaging
Aortic Valve / physiopathology*
Aortic Valve / surgery
Aortic Valve Insufficiency / diagnostic imaging
Aortic Valve Insufficiency / physiopathology*
Aortic Valve Prolapse / diagnostic imaging
Aortic Valve Prolapse / physiopathology*
Biomechanical Phenomena
Echocardiography, Doppler, Color
Equipment Design
Hemodynamics*
In Vitro Techniques
Models, Cardiovascular*
Printing, Three-Dimensional
Sus scrofa
Suture Techniques
Transducers, Pressure

Abstract

Publication types

MeSH terms

Grants and funding