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Image-Guided Targeted Mitral Valve Tethering with Chordal Encircling Snares as a Preclinical Model of Secondary Mitral Regurgitation

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Abstract

Development of transcatheter mitral valve interventions has ushered a significant need for large animal models of secondary mitral regurgitation. Though currently used heart failure models that chronically develop secondary mitral regurgitation are viable, the severity is lower than patients, the incubation time is long, and mortality is high. We sought to develop a swine model of acute secondary mitral regurgitation that uses image-guided placement of snares around the mitral chordae. Twenty-seven adult swine (n = 27) were assigned to secondary mitral regurgitation induced by valve tethering with image-guided chordal encircling snares (group 1, n = 7, tether MR (tMR)); secondary mitral regurgitation by percutaneous posterolateral myocardial infarction causing ventricular dysfunction and regurgitation (group 2, n = 6, functional MR (fMR)); and control animals (group 3, n = 14). Regurgitant fraction in tMR was 42.1 ± 14.2%, in fMR was 22 ± 9.6%, and in controls was 5.3 ± 3.8%. Mitral tenting height was 9.6 ± 1.3 mm in tMR, 10.1 ± 1.5 mm in fMR, and 5.8 ± 1.2 mm in controls. Chordal encircling tethers reproducibly induce clinically relevant levels of secondary mitral regurgitation, providing a new animal model for use in translational research.

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Abbreviations

SMR:

Secondary mitral regurgitation

HF:

Heart failure

MV:

Mitral valve

LV:

Left atrium

PMPM:

Posteromedial papillary muscle

ALPM:

Anterolateral papillary muscle

EDV:

End-diastolic volume

ESV:

End-systolic volume

EF:

Ejection fraction

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Acknowledgements

The authors acknowledge the veterinary staff that provided anesthesia support during the procedures.

Funding

This work was funded by grants from the National Institutes of Health HL135145, HL140325, and HL133667, and infrastructure support from the Carlyle Fraser Heart Center at Emory University Hospital Midtown to M. Padala.

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Authors and Affiliations

  1. Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, USA

    Daisuke Onohara, Kirthana Sreerangathama Suresh, Michael Silverman, Qi He, Takanori Kono & Muralidhar Padala

  2. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Daisuke Onohara & Muralidhar Padala

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  1. Daisuke Onohara
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  2. Kirthana Sreerangathama Suresh
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Correspondence to Muralidhar Padala.

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Ethics Approval

Human studies were not carried out by the authors for this article. All institutional and national guidelines for the care and use of laboratory animals were followed and approved by the appropriate institutional committees.

Competing Interests

M. Padala received consulting fees from Heart Repair Technologies, Inc., and Boston Scientific, which did not have any role in this work, nor did they sponsor and review this submission. M. Padala is a founder of Nyra Medical Inc. and reports significant stock ownership in it, which did not have any role in this study. K. Suresh reports minority stock ownership in Nyra Medical. The other authors declare no competing interests.

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Onohara, D., Suresh, K.S., Silverman, M. et al. Image-Guided Targeted Mitral Valve Tethering with Chordal Encircling Snares as a Preclinical Model of Secondary Mitral Regurgitation. J. of Cardiovasc. Trans. Res. 15, 653–665 (2022). https://doi.org/10.1007/s12265-021-10177-x

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