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Functional Tricuspid Regurgitation Model in a Beating Heart Platform

Jaworek, Michal*†; Piola, Marco*; Lucherini, Federico*†; Gelpi, Guido†‡; Castagna, Marco*; Lentini, Giuliana*; Antona, Carlo†‡; Fiore, Gianfranco B.*†; Vismara, Riccardo*†

doi: 10.1097/MAT.0000000000000510
Biomedical Engineering

Currently, clinicians are seeking new, minimally invasive treatment options for functional tricuspid regurgitation (FTR). Challenging tricuspid complexity requires the evaluation of the treatment techniques in adequate and realistic preclinical scenario. The purpose of this article is to describe the design and functional assessment of a novel passive beating heart model of the pulmonary circulation with the possibility to tightly control FTR. The model housed porcine hearts actuated by a volumetric pump that cyclically pressurized the right ventricle. The in-vitro FTR model exploited the tendency of the ventricle to dilate under pressure. The dilation entailed papillary muscles displacement and valve annulus enlargement, thus inducing tricuspid valve insufficiency. Employment of constraint bands allowed to restore valve competency. The system provided consistent replication of the main determinants of the pulmonary hemodynamics in a wide range of working conditions. The experimental model of FTR was reliable, easily controllable, and showed good stability-over-time. Echocardiography and fiberscope imaging provided a unique opportunity to investigate valve dynamics. These features make the platform suitable for realistic training purposes and testing of the upcoming FTR therapies.

Supplemental Digital Content is available in the text.

From the *Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy; ForcardioLab – Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy; and Cardiovascular Department, ‘Luigi Sacco’ General Hospital, Milan, Italy.

Submitted for consideration July 2016; accepted for publication in revised form December 2016.

Disclosure: The authors have no conflicts of interest to report.

This work was supported in part by the European Commission within the Horizon 2020 Framework through the MSCA-ITN-ETN European Training Networks (Project Number 642458) and by Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Correspondence: Michal Jaworek, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133 Milan, Italy. Email:

Copyright © 2017 by the American Society for Artificial Internal Organs