Paper: The dynamic cardiac biosimulator / A method for training physicians in beating-heart mitral valve repair procedures

Paper

The Dynamic Cardiac Biosimulator

a Method for Training Physicians in Beating-Heart Mitral Valve Repair Procedures

The Journal of Thoracic and Cardiovascular Surgery, Vol. 155, Issue 1, p147–155

Key Words:

simulation | biosimulator | mitral valve | chord | replacement

Authors:

Alberto M. Leopaldi, PhD | Krzysztof Wrobel, MD | Giovanni Speziali, MD | Sjoerd van Tuijl, BSc | Agne Drasutiene, MD | W. Randolph Chitwood Jr, MD

Purpose of this study:

A dynamic animal heart biosimulator is evaluated during extruded polytetrafluoroethylene artificial chordae implantation into flailing mitral leaflets under echocardiographic navigation. Concomitant hemodynamic changes are displayed simultaneously.

Abstract

Previously, cardiac surgeons and cardiologists learned to operate new clinical devices for the first time in the operating room or catheterization laboratory. We describe a biosimulator that recapitulates normal heart valve physiology with associated real-time hemodynamic performance.

Methods

To highlight the advantages of this simulation platform, transventricular extruded polytetrafluoroethylene artificial chordae were attached to repair flail or prolapsing mitral valve leaflets. Guidance for key repair steps was by 2-dimensional / 3-dimensional echocardiography and simultaneous intracardiac videoscopy.

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Results

Multiple surgeons have assessed the use of this biosimulator during artificial chordae implantations. This simulation platform recapitulates normal and pathologic mitral valve function with associated hemodynamic changes. Clinical situations were replicated in the simulator and echocardiography was used for navigation, followed by videoscopic confirmation.

This beating heart biosimulator (ed.: LifeTec Group’s Cardiac Biosimulator Platform) reproduces prolapsing mitral leaflet pathology. It may be the ideal platform for surgeon and cardiologist training on many transcatheter and beating heart procedures.  

- - >> (Journal Thorac Cardiovascular Surgery 2018, 155:147-55) 

Technique

"Although the biosimulator can be used to evaluate any type of intracardiac device, procedure, and/or other types of structural heart disease, our goal was to train surgeons to perform off-pump transventricular mitral valve repairs on prolapsed or flail mitral valve leaflets. The ex vivo heart simulator was an optimal tool for preclinical training because of the combined benefits of bimodal intracardiac visualization, pathologic and hemodynamic replication, operative rehearsal, and postprocedure skill assessment. The DS1000 system (NeoChord, Inc, St Louis Park, Minn) is a commercially available device that is intended to treat patients having mitral valve regurgitation resulting from prolapsed or flail mitral valve leaflets that are secondary to ruptured or elongated native chordae tendineae. This technology was used as the control technology to assess the preclinical teaching potential using this biosimulator.

[complete journal pulication:]

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Relevant links and background information

- Cardiac Biosimulator Platform [link]

- LifeTec Group, preclinical contract research [link]

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