Abstract
There has been a resurgence of interest in the treatment of severe functional tricuspid regurgitation (FTR) due to the awareness of its poor outcomes and potential percutaneous therapies. Kay bicuspidization has been adapted in percutaneous therapies but its clinical outcome remains uncertain. The present study evaluates the efficacy of Kay repair in a novel ex vivo pulsatile system. Porcine tricuspid valve (TV) (n = 3) was extracted and incorporated into a patient-specific silicon right ventricle (RV) emulating severe FTR, on which Kay repair was subsequently performed. TV area metrics and RV hemodynamic assessment by means of stereo-scopic particle image velocimetry were quantified in both FTR and post-repair conditions. Bicuspidization led to significant increase in cardiac output although the overall increment due to this approach alone was generally small, possibly due to existence of residual TR and the large reduction in TV opening area. Kinetic energy and viscous loss levels were increased post-repair, especially during diastolic filling. Main vortex structures generally maintained post-procedural. However, there was enhanced swirling motion in larger RV domain. Although this might reduce mural-thrombus risk, the relatively more complex vortex phenomenon likely resulted in elevated viscous loss observed and may potentially impact long-term adaptation. The RV hemodynamic alteration after tricuspid repair could be used to predict the success of these future transcatheter solutions.
Highlights
The most common mechanism of clinically relevant tricuspid regurgitation (TR) is functional TR (FTR) in which right ventricular (RV) enlargement and/or tricuspid annular (TA) dilatation result in tricuspid valve (TV) malfunction despite the intact TV apparatus[1]
A total of nine cases were tested in the flow loop, for which the cardiac output (CO) was assessed before (FTR state) and after Kay bicuspidization repair
TV area and right ventricle (RV) hemodynamic characteristics before and after Kay bicuspidization repair in a severe functional tricuspid regurgitation (FTR) situation exhibiting both severe RV and TA dilatations were investigated for the first time in a novel ex vivo right heart simulator by means of stereo-scopic particle image velocimetry (PIV)
Summary
The most common mechanism of clinically relevant tricuspid regurgitation (TR) is functional TR (FTR) in which right ventricular (RV) enlargement and/or tricuspid annular (TA) dilatation result in TV malfunction despite the intact TV apparatus[1]. One of the common FTR surgical treatment options is Kay bicuspidization repair, in which the 2 points at annular region along the posterior leaflet is apposed together by sutures, essentially plicating the posterior leaflet[5]. This leads to a double-leaflet configuration formed by the anterior and septal leaflets, the name “bicuspidization”. A few in vivo[8,9,10,11] and in silico[12,13] studies have looked into the details of physiological RV flow, and there is yet no attempt to quantify RV hemodynamics after different surgical procedures such as those done on atrio-ventricular valve. To the best of our knowledge, this is the first attempt to characterize the RV hemodynamics after any TV repair therapy
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