Name: Preparation of Left Ventricular Outflow Tract (LVOT) from Porcine Heart for Cannulation
Uploaded: 2023-08-25T15:00:00
Description: Watch this Scientific Journal Video about Preparation of Left Ventricular Outflow Tract LVOT from Porcine Heart for Cannulation at JoVE.com

preparation of left ventricular outflow tract (lvot) from porcine heart for cannulation 

Evaluatie van hydrodynamische eigenschappen in gemonteerde varkensaortakleppen

Aortic valve disease represents a significant public health burden, particularly aortic stenosis, which affects 9 million people worldwide1. Strategies to address this disease are currently evolving and include aortic valve repair and aortic valve replacement. In the pediatric population especially, there is a significant incentive to repair rather than replace the valve since currently available prostheses are prone to structural valve degeneration (SVD) and are not growth tolerant, requiring reoperation for re-replacement as the patient grows. Even the Ross procedure, which replaces the diseased aortic valve (AV) with the native pulmonary valve (PV), requires a prosthesis or graft in the pulmonary position that is also subject to SVD and often limited growth tolerance2. New approaches to aortic valve disease are being developed, and there is a need for testing in a biologically relevant context prior to application in a large animal model.
We have developed a method for testing a porcine AV that can provide insights into the function of the valve before and after an investigational procedure or application of a novel medical device. By mounting the porcine AV on a commercially available pulse duplicator machine, we are able to compare the hydrodynamic characteristics that are commonly used in the investigation and ultimately approval of valve prostheses, including regurgitation fraction (RF), effective orifice area (EOA), and mean positive pressure difference (PPD)3,4. The intervention can then be fine-tuned in a biologically relevant context before use in a large animal model, thus limiting the number of animals needed to produce a procedure or prosthesis that can be used in humans. The hearts used for this experiment can be obtained from the local abattoir or waste tissue from other experiments, so it is not necessary to sacrifice an animal solely for the purposes of this experiment.
In our work, we used this method to develop a novel patch material for valve repair and replacement. We tested the hydrodynamic function of a variety of patch materials by performing an aortic valve neocuspidization procedure (Ozaki procedure5,6,7) on porcine AVs and testing them in the pulse duplicator before and after the procedure. This enabled us to fine-tune the material based on its hydrodynamic performance. Thus, this method provides a platform for hydrodynamic testing of experimental procedures and novel medical devices for use on the AV prior to application&#160;in a large animal model.

Auteur in de schijnwerpers: het testen van cardiale procedures bevorderen voordat aan grote dierstudies wordt begonnen 

Een ex vivo varkensmodel voor hydrodynamisch testen van experimentele aortaklepprocedures en nieuwe medische hulpmiddelen

Limited options exist for testing new cardiac procedures and investigative medical devices before use in a large animal model. Our protocol provides the opportunity to fine-tune such procedures and devices in a biologically and anatomically relevant context prior to embarking on large animal studies. Other techniques for mounting an aortic valve on a pulse duplicator require inserting or fixing a rigid structure to the aortic valve annulus, thus distorting the valve's hydrodynamic properties.Our protocol offers an innovative way to cannulate the LVOT so that all measured hydrodynamic properties are valid. This method is designed to assess the viability of leaflet substitution materials for use as a valve repair patch or prosthesis. It is a pivotal tool for our future research in which we are developing biomimetic polymeric materials for use as durable valve substitutives with native tissue, like mechanical and hydrodynamic properties.

Watch this Scientific Journal Video about Preparation of Left Ventricular Outflow Tract LVOT from Porcine Heart for Cannulation at JoVE.com

Preparation of Left Ventricular Outflow Tract (LVOT) from Porcine Heart for Cannulation   

Voorbereiding van het linkerventrikeluitstroomkanaal (LVOT) van het varkenshart voor canulatie 

Verzamel om te beginnen een vers hartmonster van varkens na cardiectomie. Ontleed de longslagader van de aorta met een Metzenbaum-schaar totdat ventrikelweefsel zichtbaar is. Ontleed vervolgens de rechter en de linker kransslagaders en maak ze vast met zijden banden aan hun oorsprong van de aorta-sinussen zonder de sinussen te vernauwen.Doorsnijd de kransslagaders distaal van de zijden banden. Maak met een Metzenbaum-schaar een insnijding in de rechterhartkamer tussen de aorta en de longslagader aan de basis van de longklep. Begin naar voren en vervolg de incisie in de omtrek langs het intraventriculaire septum om de vrije wand van de rechterventrikel te verwijderen.Vervolg de incisie naar achteren door de annulus van de tricuspidalisklep langs het interatriale septum om al het juiste atriale weefsel te verwijderen. Snijd vervolgens met een Metzenbaum-schaar het linker atrium in door het ostium van de rechter longader evenwijdig aan de aorta. Vervolg deze incisie in de richting van de anterolaterale commissuur van de mitralisklep.Snijd overtollig weefsel in het linker atrium af terwijl u de manchet van drie millimeter atriumweefsel op de aorta en de mitralisklepannulus omtrek behoudt. Verleng nu de incisie naar de linker hartkamer door de anterolaterale commissuur van de mitralisklep zonder de anterolaterale papillaire spier te beschadigen. Verdeel de chordae tendineae van de anterolaterale papillaire spier naar het achterste mitralisklepblad, met behoud van de aanhechtingen aan het voorste mitralisklepblad.Verleng de incisie tot aan de top van het hart. Snijd overtollig linkerventrikelweefsel onder de papillaire spieren af, waarbij beide papillaire spieren behouden blijven.

Research

JoVE Journal

Bioengineering

Preparation of Left Ventricular Outflow Tract (LVOT) from Porcine Heart for Cannulation 

An Ex Vivo Porcine Model for Hydrodynamic Testing of Experimental Aortic Valve Procedures and Novel Medical Devices

The options for testing new cardiac procedures and investigative medical devices prior to use in an animal model are limited. In this study, we present a ...