Development of a High-Fidelity Beating Heart Simulator for Mitral Valve Interventions

Milan Even

January 2024

Mitral valve regurgitation (MR) is a heart condition where blood leaks backward through the mitral valve with each heartbeat. Researchers have been working on various treatments, from surgeries to less invasive procedures. However, testing these interventions has been challenging due to the lack of a realistic model that accurately mimics the complexities of the mitral valve and its surroundings.

To address this issue, scientists have developed a high-fidelity beating heart simulator designed for testing interventions related to mitral valve repair and replacement. The primary goal is to create a reliable and cost-effective alternative to animal testing, providing a controlled environment for testing the feasibility, performance, and design of mitral valve devices.

The simulator combines preserved intracardiac tissue with soft robotic cardiac muscles, creating a biohybrid system. Unlike traditional cardiovascular simulators that use a passive heart structure and external pumps for blood flow, this model employs biomimetic soft robotic actuators to replicate the natural motion of the left ventricular myocardium. The design includes essential anatomical features of the mitral valve, such as the annulus, leaflets, chordae tendineae, and papillary muscles.

Key Features:

Realistic Motion: The biomimetic soft robotic myocardium generates lifelike cardiac motion, including squeezing, twisting, and interventricular septal motion, ensuring accurate replication of mitral valve function.

Controllability: The simulator allows precise control over cardiac motion, heart rate, and valve function, offering a more controlled testing environment compared to animal models.

Visibility and Data Collection: The platform provides direct visibility of the intracardiac environment using optically clear fluid and endoscopic cameras. It enables real-time measurement of hemodynamic parameters, giving instant feedback on surgical repairs or device deployment.

The researchers conducted simulations of acute MR through chordae rupture, employing various surgical and interventional techniques, including chordal repair, surgical bioprosthetic valve replacement, and transcatheter edge-to-edge repair (TEER). Collaborating with clinicians, they successfully demonstrated the elimination of regurgitant flow after valve replacement and the effectiveness of TEER procedures.

The simulator serves as a valuable tool for training cardiac surgeons and interventional cardiologists in mitral valve procedures. It allows practitioners to rehearse interventions under realistic conditions, enhancing their skills and reducing complications associated with the learning curve of new procedures. Moreover, the simulator can be employed to test various surgical and percutaneous methods for treating mitral valve diseases, providing insights into potential complications and guiding the development of new devices.

In conclusion, the development of this high-fidelity beating heart simulator represents a significant advancement in preclinical testing for mitral valve interventions. By combining preserved heart tissue with soft robotic technology, the platform offers a realistic and controllable environment for testing and refining medical devices and procedures. The potential applications extend beyond mitral valve interventions, with implications for other intracardiac devices. This innovation bridges the gap between benchtop testing and real-world applications, ultimately benefiting both medical professionals and patients through improved procedural planning and expedited device approvals.

References

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Park, C., Singh, M., Saeed, M. Y., Nguyen, C. T., & Roche, E. T. (2024). Biorobotic hybrid heart as a benchtop cardiac mitral valve simulator. Device, 1(1), 100217. https://doi.org/10.1016/j.device.2023.100217