Establishment of mitral regurgitation model by a transapical artificial chordae tendineae implantation device in swines_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHONG Lishan ¹ , YANG Yanchen ² , HUANG Yanying ^1,3 , WANG Zhenzhong ¹ , XIAO Shuo ^1,4 , FANG Dou ^1,5 , WANG Qiuji ⁶ , XIE Qizong ⁷ , ZHANG Xusheng ⁷ , WU Haiming ⁷ ,  HUANG Huanlei ^1,6

1. Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China;
2. The First People’s Hospital of Foshan, Foshan, 528000, Guangdong, P. R. China;
3. Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
4. South China University of Technology, Guangzhou, 510641, P. R. China;
5. Southern Medical University, Guangzhou, 510515, P. R. China;
6. Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China;
7. Hanxin Medical Technology (Shenzhen) Co., Ltd., Shenzhen, 518109, P. R. China;

Corresponding?author：

HUANG Huanlei, Email: huanghuanlei@gdph.org.cn

Keywords：

Mitral regurgitation; animal model; transapical; artificial chordae tendineae implantation device

DOI：

10.7507/1007-4848.202208053

Video：

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Objective To research the procedure for creating an animal model of mitral regurgitation by implanting a device through the apical artificial chordae tendineae, and to assess the stability and dependability of the device. Methods Twelve large white swines were employed in the experiments. Through a tiny hole in the apex of the heart, the artificial chordae tendineae of the mitral valve was inserted under the guidance of transcardiac ultrasonography. Before, immediately after, and one and three months after surgery, cardiac ultrasonography signs were noted. Results All models were successfully established. During the operation and the follow-up, no swines died. Immediately after surgery, the mitral valve experienced moderate regurgitation. Compared with preoperation, there was a variable increase in the amount of regurgitation and the values of heart diameters at a 3-month follow-up (P<0.05). Conclusion In off-pump, the technique of pulling the mitral valve leaflets with chordae tendineae implanted transapically under ultrasound guidance can stably and consistently create an animal model of mitral regurgitation.

Citation： ZHONG Lishan, YANG Yanchen, HUANG Yanying, WANG Zhenzhong, XIAO Shuo, FANG Dou, WANG Qiuji, XIE Qizong, ZHANG Xusheng, WU Haiming, HUANG Huanlei. Establishment of mitral regurgitation model by a transapical artificial chordae tendineae implantation device in swines. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(4): 570-575. doi: 10.7507/1007-4848.202208053 Copy

1.	中國生物醫學工程學會體外循環分會. 2019年中國心外科手術和體外循環數據白皮書. 中國體外循環雜志, 2020, 18(4): 193-196.
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11.	Padala M, Cardinau B, Gyoneva LI, et al. Comparison of artificial neochordae and native chordal transfer in the repair of a flail posterior mitral leaflet: An experimental study. Ann Thorac Surg, 2013, 95(2): 629-633.
12.	Ge Z, Pan W, Pan C, et al. The effect of a novel transcatheter edge-to-edge mitral valve repair device in a porcine model of mitral regurgitation. Acta Cardiol Sin, 2020, 36(6): 620-625.
13.	Imbrie-Moore AM, Paullin CC, Paulsen MJ, et al. A novel 3D-printed preferential posterior mitral annular dilation device delineates regurgitation onset threshold in an ex vivo heart simulator. Med Eng Phys, 2020, 77: 10-18.
14.	Jaworek M, Mangini A, Maroncelli E, et al. Ex vivo model of functional mitral regurgitation using deer hearts. J Cardiovasc Transl Res, 2021, 14(3): 513-524.
15.	Padala M, Gyoneva LI, Thourani VH, et al. Impact of mitral valve geometry on hemodynamic efficacy of surgical repair in secondary mitral regurgitation. J Heart Valve Dis, 2014, 23(1): 79-87.
16.	Pu M, Gao Z, Li J, et al. Development of a new animal model of chronic mitral regurgitation in rats under transesophageal echocardiographic guidance. J Am Soc Echocardiogr, 2005, 18(5): 468-474.
17.	Sielicka A, Sarin EL, Shi W, et al. Pathological remodeling of mitral valve leaflets from unphysiologic leaflet mechanics after undersized mitral annuloplasty to repair ischemic mitral regurgitation. J Am Heart Assoc, 2018, 7(21): e009777.
18.	Lai DT, Tibayan FA, Myrmel T, et al. Mechanistic insights into posterior mitral leaflet inter-scallop malcoaptation during acute ischemic mitral regurgitation. Circulation, 2002, 106(12 Suppl 1): I40-I45.
19.	Timek TA, Dagum P, Lai DT, et al. Pathogenesis of mitral regurgitation in tachycardia-induced cardiomyopathy. Circulation, 2001, 104(12 Suppl 1): I47-I53.
20.	Fukamachi K, Inoue M, Popovi? ZB, et al. Off-pump mitral valve repair using the Coapsys device: A pilot study in a pacing-induced mitral regurgitation model. Ann Thorac Surg, 2004, 77(2): 688-692.
21.	Yamauchi H, Feins EN, Vasilyev NV, et al. Creation of nonischemic functional mitral regurgitation by annular dilatation and nonplanar modification in a chronic in vivo swine model. Circulation, 2013, 128(11 Suppl 1): S263-S270.
22.	Agra EJ, Suresh KS, He Q, et al. Left ventricular thinning and distension in pig hearts as a reproducible ex vivo model of functional mitral regurgitation. ASAIO J, 2020, 66(9): 1016-1024.
23.	Onohara D, Suresh KS, Silverman M, et al. Image-guided targeted mitral valve tethering with chordal encircling snares as a preclinical model of secondary mitral regurgitation. J Cardiovasc Transl Res, 2022, 15(3): 653-665.
24.	Imbrie-Moore AM, Paulsen MJ, Zhu Y, et al. A novel cross-species model of Barlow's disease to biomechanically analyze repair techniques in an ex vivo left heart simulator. J Thorac Cardiovasc Surg, 2021, 161(5): 1776-1783.
25.	Koprivanac M, Kelava M, Alansari S, et al. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques. Ann Cardiothorac Surg, 2017, 6(1): 38-46.

1. 中國生物醫學工程學會體外循環分會. 2019年中國心外科手術和體外循環數據白皮書. 中國體外循環雜志, 2020, 18(4): 193-196.
2. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
3. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
4. Gaidulis G, Suresh KS, Xu D, et al. Patient-specific three-dimensional ultrasound derived computational modeling of the mitral valve. Ann Biomed Eng, 2022, 50(7): 847-859.
5. Li D, Ren BH, Shen Y, et al. A swine model for long-term evaluation of prosthetic heart valves. ANZ J Surg, 2007, 77(8): 654-658.
6. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr, 2003, 16(7): 777-802.
7. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: A report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr, 2005, 18(12): 1440-1463.
8. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med, 2005, 352(9): 875-883.
9. Delling FN, Vasan RS. Epidemiology and pathophysiology of mitral valve prolapse: New insights into disease progression, genetics, and molecular basis. Circulation, 2014, 129(21): 2158-2170.
10. Li B, Cui Y, Zhang D, et al. The characteristics of a porcine mitral regurgitation model. Exp Anim, 2018, 67(4): 463-477.
11. Padala M, Cardinau B, Gyoneva LI, et al. Comparison of artificial neochordae and native chordal transfer in the repair of a flail posterior mitral leaflet: An experimental study. Ann Thorac Surg, 2013, 95(2): 629-633.
12. Ge Z, Pan W, Pan C, et al. The effect of a novel transcatheter edge-to-edge mitral valve repair device in a porcine model of mitral regurgitation. Acta Cardiol Sin, 2020, 36(6): 620-625.
13. Imbrie-Moore AM, Paullin CC, Paulsen MJ, et al. A novel 3D-printed preferential posterior mitral annular dilation device delineates regurgitation onset threshold in an ex vivo heart simulator. Med Eng Phys, 2020, 77: 10-18.
14. Jaworek M, Mangini A, Maroncelli E, et al. Ex vivo model of functional mitral regurgitation using deer hearts. J Cardiovasc Transl Res, 2021, 14(3): 513-524.
15. Padala M, Gyoneva LI, Thourani VH, et al. Impact of mitral valve geometry on hemodynamic efficacy of surgical repair in secondary mitral regurgitation. J Heart Valve Dis, 2014, 23(1): 79-87.
16. Pu M, Gao Z, Li J, et al. Development of a new animal model of chronic mitral regurgitation in rats under transesophageal echocardiographic guidance. J Am Soc Echocardiogr, 2005, 18(5): 468-474.
17. Sielicka A, Sarin EL, Shi W, et al. Pathological remodeling of mitral valve leaflets from unphysiologic leaflet mechanics after undersized mitral annuloplasty to repair ischemic mitral regurgitation. J Am Heart Assoc, 2018, 7(21): e009777.
18. Lai DT, Tibayan FA, Myrmel T, et al. Mechanistic insights into posterior mitral leaflet inter-scallop malcoaptation during acute ischemic mitral regurgitation. Circulation, 2002, 106(12 Suppl 1): I40-I45.
19. Timek TA, Dagum P, Lai DT, et al. Pathogenesis of mitral regurgitation in tachycardia-induced cardiomyopathy. Circulation, 2001, 104(12 Suppl 1): I47-I53.
20. Fukamachi K, Inoue M, Popovi? ZB, et al. Off-pump mitral valve repair using the Coapsys device: A pilot study in a pacing-induced mitral regurgitation model. Ann Thorac Surg, 2004, 77(2): 688-692.
21. Yamauchi H, Feins EN, Vasilyev NV, et al. Creation of nonischemic functional mitral regurgitation by annular dilatation and nonplanar modification in a chronic in vivo swine model. Circulation, 2013, 128(11 Suppl 1): S263-S270.
22. Agra EJ, Suresh KS, He Q, et al. Left ventricular thinning and distension in pig hearts as a reproducible ex vivo model of functional mitral regurgitation. ASAIO J, 2020, 66(9): 1016-1024.
23. Onohara D, Suresh KS, Silverman M, et al. Image-guided targeted mitral valve tethering with chordal encircling snares as a preclinical model of secondary mitral regurgitation. J Cardiovasc Transl Res, 2022, 15(3): 653-665.
24. Imbrie-Moore AM, Paulsen MJ, Zhu Y, et al. A novel cross-species model of Barlow's disease to biomechanically analyze repair techniques in an ex vivo left heart simulator. J Thorac Cardiovasc Surg, 2021, 161(5): 1776-1783.
25. Koprivanac M, Kelava M, Alansari S, et al. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques. Ann Cardiothorac Surg, 2017, 6(1): 38-46.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Establishment of mitral regurgitation model by a transapical artificial chordae tendineae implantation device in swines

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