Importance of Preserved Tricuspid Valve Function for Effective Soft Robotic Augmentation of the Right Ventricle in Cases of Elevated Pulmonary Artery Pressure,Cardiovascular Engineering and Technology

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Importance of Preserved Tricuspid Valve Function for Effective Soft Robotic Augmentation of the Right Ventricle in Cases of Elevated Pulmonary Artery Pressure
Cardiovascular Engineering and Technology ( IF 1.8 ) Pub Date : 2021-07-14 , DOI: 10.1007/s13239-021-00562-7
Isaac Wamala _{1,

2} , Christopher J Payne _{3,

4} , Mossab Y Saeed ₁ , Daniel Bautista-Salinas _{1,

5} , David Van Story ₁ , Thomas Thalhofer ₆ , Steven J Staffa ₇ , Sunil J Ghelani ₈ , Pedro J Del Nido ₁ , Conor J Walsh _{3,

4} , Nikolay V Vasilyev ₁

Affiliation

Purpose

In clinical practice, many patients with right heart failure (RHF) have elevated pulmonary artery pressures and increased afterload on the right ventricle (RV). In this study, we evaluated the feasibility of RV augmentation using a soft robotic right ventricular assist device (SRVAD), in cases of increased RV afterload.

Methods

In nine Yorkshire swine of 65–80 kg, a pulmonary artery band was placed to cause RHF and maintained in place to simulate an ongoing elevated afterload on the RV. The SRVAD was actuated in synchrony with the ventricle to augment native RV output for up to one hour. Hemodynamic parameters during SRVAD actuation were compared to baseline and RHF levels.

Results

Median RV cardiac index (CI) was 1.43 (IQR, 1.37–1.80) L/min/m² and 1.26 (IQR 1.05–1.57) L/min/m² at first and second baseline. Upon PA banding RV CI fell to a median of 0.79 (IQR 0.63–1.04) L/min/m². Device actuation improved RV CI to a median of 0.87 (IQR 0.78–1.01), 0.85 (IQR 0.64–1.59) and 1.11 (IQR 0.67–1.48) L/min/m² at 5 min (p = 0.114), 30 min (p = 0.013) and 60 (p = 0.033) minutes respectively. Statistical GEE analysis showed that lower grade of tricuspid regurgitation at time of RHF (p = 0.046), a lower diastolic pressure at RHF (p = 0.019) and lower mean arterial pressure at RHF (p = 0.024) were significantly associated with higher SRVAD effectiveness.

Conclusions

Short-term augmentation of RV function using SRVAD is feasible even in cases of elevated RV afterload. Moderate or severe tricuspid regurgitation were associated with reduced device effectiveness.

中文翻译：

在肺动脉压升高的情况下，保留三尖瓣功能对右心室有效软机器人增强的重要性

目的

在临床实践中，许多右心衰竭 (RHF) 患者的肺动脉压升高，右心室 (RV) 后负荷增加。在这项研究中，我们评估了在 RV 后负荷增加的情况下使用软机器人右心室辅助装置 (SRVAD) 增强 RV 的可行性。

方法

在 9 头 65-80 公斤的约克夏猪中，放置了一条肺动脉带以引起 RHF，并保持在适当位置以模拟 RV 上持续升高的后负荷。SRVAD 与心室同步启动，以增加原生 RV 输出长达一小时。将 SRVAD 驱动期间的血流动力学参数与基线和 RHF 水平进行比较。

结果

在第一个和第二个基线时，中位 RV 心脏指数 (CI) 为 1.43 (IQR, 1.37–1.80) L/min/m ²和 1.26 (IQR 1.05–1.57) L/min/m ^{2 。}PA 条带 RV CI 降至 0.79 (IQR 0.63–1.04) L/min/m ²的中位数。设备驱动在 5 分钟（^p= 0.114）、30 分钟（p = 0.013) 和 60 ( p = 0.033) 分钟。统计 GEE 分析显示，RHF 时三尖瓣反流程度较低（p = 0.046），RHF 时舒张压较低（p = 0.019），RHF 时平均动脉压较低（p = 0.024）与更高的 SRVAD 有效性显着相关。