A new beating-heart mitral and aortic valve assessment model with implications for valve intervention training.
A thorough understanding of mitral and aortic valve motion dynamics is essential in mastering the skills necessary for performing successful valve intervention (open or transcatheter repair or replacement). We describe a reproducible and versatile beating-heart mitral and aortic valve assessment and valve intervention training model in human cadavers.



The model is constructed by bilateral ligation of the pulmonary veins, ligation of the supra-aortic arteries, creating a shunt between the descending thoracic aorta and the left atrial appendage with a vascular prosthesis, anastomizing a vascular prosthesis to the apex and positioning an intra-aortic balloon pump (IABP) in the vascular prosthesis, cross-clamping the descending thoracic aorta, and finally placing a fluid line in the shunt prosthesis. The left ventricle is filled with saline to the desired pressure through the fluid line, and the IABP is switched on and set to a desired frequency (usually 60-80 bpm). Prerepair valve dynamic motion can be studied under direct endoscopic visualization. After assessment, the IABP is switched off, and valve intervention training can be performed using standard techniques.



This high-fidelity simulation model has known limitations, but provides a realistic environment with an actual beating (human) heart, which is of incremental value. The model provides a unique opportunity to fill a beating heart with saline and to study prerepair mitral and aortic valve dynamic motion under direct endoscopic visualization.



The entire set-up provides a versatile beating-heart mitral and aortic valve assessment model, which may have important implications for future valve intervention training.
Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Wobbe
W
Bouma
Department of Anesthesiology and Pain Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Jayant S
JS
Jainandunsing
Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Arash
A
Khamooshian
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Pim
P
van der Harst
Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Massimo A
MA
Mariani
Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Ehsan
E
Natour
D001021:Aortic Valve / Q000503:physiopathology* / Q000601:surgery; D002102:Cadaver; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D000070856:High Fidelity Simulation Training; D006801:Humans; D008943:Mitral Valve / Q000503:physiopathology* / Q000601:surgery; D008955:Models, Cardiovascular
Aortic valve; Mitral valve; Training model