title: Transcatheter Edge-to-Edge Treatment of Functional Tricuspid Regurgitation in an Ex Vivo Pulsatile Heart Model.
abstract: Although associated with left heart pathologies, functional tricuspid regurgitation (FTR) is often left untreated during left heart surgery. Hence, owing to its degenerative character, reoperation is often needed, encompassing an impressive (25% to 35%) mortality rate. Thus transcatheter approaches to FTR are raising great interest.
  
  
  
  The authors evaluated the post-treatment effectiveness of the edge-to-edge technique using the percutaneous mitral valve repair device in an ex vivo pulsatile model of FTR.
  
  
  
  The devices were implanted in 11 porcine hearts simulating FTR. In each heart, single-clip treatments involved grasping leaflet pairs in the medial or commissural position (6 combinations). Two-clip treatments were then performed considering all possible 15 combinations of leaflet pairs and medial/commissural grasping. Cardiac output, mean pulmonary pressure, and mean diastolic valve pressure gradient were evaluated in physiological and simulated pathological conditions (FTR), and post-treatments.
  
  
  
  Grasping the septal and anterior leaflets allowed for the best post-procedural outcome, ensuring a complete re-establishment of physiological-like hemodynamics. Septal and posterior grasping induced a significant recovery from FTR, although less marked. Conversely, grasping the anterior and posterior leaflets did not reduce FTR, and was detrimental in some specific cases.
  
  
  
  This experimental work demonstrated that the transcatheter edge-to-edge repair technique is a feasible approach for FTR. The study investigated this approach to develop a selective, specific structural intervention methodology for treating FTR, considering the several biomechanical factors that alter proper functionality of valvular substructures. These results can be used to guide the development of edge-to-edge repair techniques in treatment of FTR.
authors: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy. Electronic address: riccardo.vismara@polimi.it.
authors: Riccardo
authors: R
authors: Vismara
authors: ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Department, 'Luigi Sacco' General Hospital, Milan, Italy.
authors: Guido
authors: G
authors: Gelpi
authors: Abbott Vascular, Menlo Park, California.
authors: Santosh
authors: S
authors: Prabhu
authors: Abbott Vascular International, Brussels, Belgium.
authors: Paolo
authors: P
authors: Romitelli
authors: Abbott Vascular, Menlo Park, California.
authors: Lauren G
authors: LG
authors: Troxler
authors: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Department, 'Luigi Sacco' General Hospital, Milan, Italy.
authors: Andrea
authors: A
authors: Mangini
authors: ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Department, 'Luigi Sacco' General Hospital, Milan, Italy.
authors: Claudia
authors: C
authors: Romagnoni
authors: ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Department, 'Luigi Sacco' General Hospital, Milan, Italy.
authors: Monica
authors: M
authors: Contino
authors: Abbott Vascular, Menlo Park, California.
authors: Dylan T
authors: DT
authors: Van Hoven
authors: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.
authors: Federico
authors: F
authors: Lucherini
authors: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.
authors: Michal
authors: M
authors: Jaworek
authors: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.
authors: Alberto
authors: A
authors: Redaelli
authors: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy; ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.
authors: Gianfranco B
authors: GB
authors: Fiore
authors: ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Department, 'Luigi Sacco' General Hospital, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
authors: Carlo
authors: C
authors: Antona
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000295:instrumentation; D006348:Cardiac Surgical Procedures / Q000295:instrumentation / Q000379:methods; D004195:Disease Models, Animal; D066298:In Vitro Techniques; D013552:Swine; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*
keywords: anterior; leaflet; posterior; septal; transcatheter approach; tricuspid valve