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    Development of a Reproducible Swine Model of Chronic Ischemic Mitral Regurgitation: Lessons Learned.

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    Author
    Pasrija, Chetan
    Quinn, Rachael W
    Alkhatib, Hani
    Tran, Douglas
    Bernstein, Daniel
    Rice, MaryJoe
    Kotloff, Ethan
    Morales, David
    D'Ambra, Michael N
    Vesely, Mark R
    Gammie, James S
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    Date
    2020-06-15
    Journal
    Annals of Thoracic Surgery
    Publisher
    Elsevier Inc.
    Type
    Article
    Other
    
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    See at
    https://doi.org/10.1016/j.athoracsur.2020.04.112
    Abstract
    Background: Durability of mitral valve repair for ischemic mitral regurgitation (IMR) remains poor. We established a swine model of chronic IMR, and describe the methods and lessons learned from this model. Methods: Thirty-five swine underwent percutaneous myocardial infarction with ethanol ablation of the circumflex or obtuse marginal (OM) arteries. Swine were followed with routine echocardiography for the development of severe IMR. Once severe IMR was established, swine underwent mitral valve operations on cardiopulmonary bypass. After operation, swine were survived up to 7 weeks. Angiographic and echocardiographic features of swine who developed severe IMR (IMR swine) and those who did not (non-IMR swine) were compared. Results: The median number of OM arteries was 3, with 2 OM arteries infarcted. Acute survival after the myocardial infarction was 74% (26 of 35) with 3 (9%) early, postoperative deaths. Among the 23 swine with follow-up to determine IMR status, 14 of 23 (61%) developed significant IMR. Among IMR pigs, left ventricular (LV) ejection fraction decreased from 65% pre-myocardial infarction to 45% pre-mitral valve intervention (P < .001). Among non-IMR swine, LV ejection fraction decreased nonsignificantly from baseline (60%) to latest follow-up (55%) (P = .443). LV end-diastolic dimension (P = .039), wall motion score (P = .027), global circumferential strain (P = .014), and global longitudinal strain (P = .023) were significantly worse in IMR compared with non-IMR swine. Conclusions: A reproducible percutaneous model of severe IMR in swine is feasible with a guided anesthetic and perioperative approach. This model can serve as a platform to better understand the mechanism of IMR and subsequently to test novel repair techniques.
    Rights/Terms
    Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    Keyword
    Chronic Ischemic Mitral Regurgitation
    Swine
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/14380
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.athoracsur.2020.04.112
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    UMB Open Access Articles 2020

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