A tissue-hybrid right ventricular pulsatile circulatory simulator with a functional tricuspid regurgitation

We hypothesize that the development of a pulsatile circulatory simulator with physiological morphology of tricuspid valve (TV) and right ventricle is essential to evaluate the performance after tricuspid valvuloplasty. This study aimed to develop a tissue-hybrid pulsatile circulatory simulator with clinically relevant tricuspid regurgitation (TR) to evaluate the effects of tricuspid annuloplasty. The tissue-silicone hybrid model consisted of a porcine TV sutured to a silicone right ventricular model with enlarged annulus, which can be pulsated while maintaining the relative position between the TV annulus and papillary muscle. The annulus of porcine TV was enlarged by degrading collagen fibers (pre- and post- annular perimeter 115.7 ± 5.5 vs. 133.1 ± 8.2 mm; p = 0.036). Severe TR models were successfully produced (pre- and post- regurgitation 0.64 ± 0.22 vs. 3.1 ± 0.59 L/min p = 0.0002). After the TV annuloplasty, regurgitation was reduced to a clinically mild grade (pre- and post-regurgitation 3.1 ± 0.59 vs 1.2 ± 0.27 L/min p = 0.013). The regurgitant jet in TR models was remarkably reduced after the annuloplasty. The novel tissue-hybrid system was useful to simulate severe TR and quantify the effects of the annuloplasty. The simulator would be useful to evaluate efficacy of emerging medical treatments and optimize them.