{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:35:30Z","timestamp":1792636530631,"version":"4.5.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T00:00:00Z","timestamp":1699574400000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["21K08832"],"award-info":[{"award-number":["21K08832"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Transcatheter mitral valve repair is an emerging alternative to the surgical repair. This technology requires preclinical studies to assess efficacy in mitigating mitral regurgitation (MR). However, ex vivo MR models are not established. We developed 2 novel repairable models, functional and degenerative, which can quantitatively assess regurgitation and effect of intervention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We used porcine mitral valves and a pulsatile flow circulation system. In the functional MR model, the annulus was immersed in 0.1% collagenase solution and dilated using 3D-printed dilators. To control the regurgitation grade, the sizes of the dilator and silicone sheet in which the valve was sutured to were adjusted. Chordae of P2 were severed in the degenerative model, and the number of severed chordae was adjusted to control the regurgitation grade. Models were repaired using the edge-to-edge or artificial chordae technique.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The mean regurgitant fraction of the moderate\u2013severe functional and degenerative models were 47.9% [standard deviation (SD): 2.2%] and 58.5% (SD: 8.0%), which were significantly reduced to 28.7% (SD: 4.4%) (P\u2009&amp;lt;\u20090.001) and 26.0% (SD: 4.4%) (P\u2009&amp;lt;\u20090.001) after the valve repair procedures. Severe functional model had a mean regurgitant fraction of 59.4% (SD: 6.0%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Both functional and degenerative models could produce sufficient MR levels that meet the interventional indication criteria. The repairable models are valuable in evaluating the efficacy of valve repair procedures and devices. The ability to control the amount of regurgitation enhances the versatility and reliability of these models. These reproducible models could expedite the development of novel devices.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezad371","type":"journal-article","created":{"date-parts":[[2023,11,12]],"date-time":"2023-11-12T00:17:36Z","timestamp":1699748256000},"source":"Crossref","is-referenced-by-count":2,"title":["Repairable <i>ex vivo<\/i> model of functional and degenerative mitral regurgitation"],"prefix":"10.1093","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1189-9598","authenticated-orcid":false,"given":"Hayato","family":"Morimura","sequence":"first","affiliation":[{"name":"Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusei","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jumpei","family":"Takada","sequence":"additional","affiliation":[{"name":"Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8718-0088","authenticated-orcid":false,"given":"Minoru","family":"Tabata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Juntendo University , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3994-5509","authenticated-orcid":false,"given":"Kiyotaka","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University , Tokyo, Japan"},{"name":"Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University , Tokyo, Japan"},{"name":"Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University , Tokyo, Japan"},{"name":"Institute for Medical Regulatory Science, Waseda University , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,10]]},"reference":[{"key":"2023112114311611400_ezad371-B1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.3390\/medsci10020032","article-title":"Valvular Heart Disease Epidemiology","volume":"10","author":"Aluru","year":"2022","journal-title":"Medical Sciences"},{"key":"2023112114311611400_ezad371-B2","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/S0140-6736(18)30473-2","article-title":"Outcome and undertreatment of mitral regurgitation: a community cohort study","volume":"391","author":"Dziadzko","year":"2018","journal-title":"Lancet"},{"key":"2023112114311611400_ezad371-B3","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1093\/eurheartj\/ehm001","article-title":"What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery?","volume":"28","author":"Mirabel","year":"2007","journal-title":"Eur Heart J"},{"key":"2023112114311611400_ezad371-B4","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/j.jacc.2015.12.054","article-title":"Initial experience with commercial transcatheter mitral valve repair in the United States","volume":"67","author":"Sorajja","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2023112114311611400_ezad371-B5","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/j.jcin.2016.12.280","article-title":"Elevated mitral valve pressure gradient after MitraClip implantation deteriorates long-term outcome in patients with severe mitral regurgitation and severe heart failure","volume":"10","author":"Neuss","year":"2017","journal-title":"JACC Cardiovasc Interv"},{"key":"2023112114311611400_ezad371-B6","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1161\/01.CIR.0000163547.03188.AC","article-title":"Percutaneous mitral valve repair for chronic ischemic mitral regurgitation: a real-time three-dimensional echocardiographic study in an ovine model","volume":"111","author":"Daimon","year":"2005","journal-title":"Circulation"},{"issue":"Suppl 1","key":"2023112114311611400_ezad371-B7","first-page":"Ii116","article-title":"Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation","volume":"108","author":"Tibayan","year":"2003","journal-title":"Circulation"},{"key":"2023112114311611400_ezad371-B8","doi-asserted-by":"crossref","first-page":"S263","DOI":"10.1161\/CIRCULATIONAHA.112.000396","article-title":"Creation of nonischemic functional mitral regurgitation by annular dilatation and nonplanar modification in a chronic in vivo swine model","volume":"128","author":"Yamauchi","year":"2013","journal-title":"Circulation"},{"key":"2023112114311611400_ezad371-B9","doi-asserted-by":"crossref","first-page":"2324","DOI":"10.1007\/s10439-017-1885-6","article-title":"Modelling of lesions associated with functional mitral regurgitation in an ex vivo platform","volume":"45","author":"Jaworek","year":"2017","journal-title":"Ann Biomed Eng"},{"key":"2023112114311611400_ezad371-B10","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1093\/ejcts\/ezz258","article-title":"Mitral chordae tendineae force profile characterization using a posterior ventricular anchoring neochordal repair model for mitral regurgitation in a three-dimensional-printed ex vivo left heart simulator","volume":"57","author":"Paulsen","year":"2020","journal-title":"Eur J Cardiothorac Surg"},{"key":"2023112114311611400_ezad371-B11","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12872-022-02515-x","article-title":"Ex vivo biomechanical analysis of flexible versus rigid annuloplasty rings in mitral valves using a novel annular dilation system","volume":"22","author":"Zhu","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"2023112114311611400_ezad371-B12","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/j.jbiomech.2014.01.044","article-title":"Tension to passively cinch the mitral annulus through coronary sinus access: an ex vivo study in ovine model","volume":"47","author":"Bhattacharya","year":"2014","journal-title":"J Biomech"},{"key":"2023112114311611400_ezad371-B13","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s12265-020-10071-y","article-title":"Ex vivo model of functional mitral regurgitation using deer hearts","volume":"14","author":"Jaworek","year":"2021","journal-title":"J Cardiovasc Transl Res"},{"key":"2023112114311611400_ezad371-B14","doi-asserted-by":"crossref","first-page":"E275","DOI":"10.1532\/hsf.1947","article-title":"Left ventricular dilatation and posterior papillary muscle displacement in an ex vivo pulsatile model of functional mitral regurgitation","volume":"21","author":"Kradangnga","year":"2018","journal-title":"Heart Surg Forum"},{"key":"2023112114311611400_ezad371-B15","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1177\/1556984520930336","article-title":"A novel quantitative ex vivo model of functional mitral regurgitation","volume":"15","author":"Pasrija","year":"2020","journal-title":"Innovations (Phila)"},{"key":"2023112114311611400_ezad371-B16","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1007\/s12265-021-10182-0","article-title":"Mitral valve translocation: optimization of patch geometry in an ex vivo model of secondary mitral regurgitation","volume":"15","author":"Quinn","year":"2022","journal-title":"J Cardiovasc Transl Res"},{"key":"2023112114311611400_ezad371-B17","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1161\/01.CIR.96.6.1826","article-title":"Integrated mechanism for functional mitral regurgitation: leaflet restriction versus coapting force: in vitro studies","volume":"96","author":"He","year":"1997","journal-title":"Circulation"},{"key":"2023112114311611400_ezad371-B18","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.medengphy.2020.01.005","article-title":"A novel 3D-printed preferential posterior mitral annular dilation device delineates regurgitation onset threshold in an ex vivo heart simulator","volume":"77","author":"Imbrie-Moore","year":"2020","journal-title":"Med Eng Phys"},{"key":"2023112114311611400_ezad371-B19","doi-asserted-by":"crossref","first-page":"3412","DOI":"10.1007\/s10439-021-02879-9","article-title":"Ex vivo model of ischemic mitral regurgitation and analysis of adjunctive papillary muscle repair","volume":"49","author":"Imbrie-Moore","year":"2021","journal-title":"Ann Biomed Eng"},{"key":"2023112114311611400_ezad371-B20","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/MAT.0b013e3181f74777","article-title":"Response of two annular prostheses to functional mitral regurgitation main determinants: an in vitro evaluation","volume":"56","author":"Votta","year":"2010","journal-title":"ASAIO J"},{"key":"2023112114311611400_ezad371-B21","first-page":"432","article-title":"Novel mitral repair device for the treatment of severe mitral regurgitation: preclinical ovine acute and chronic implantation model","volume":"9","author":"Hill","year":"2014","journal-title":"Innovations (Phila)"},{"key":"2023112114311611400_ezad371-B22","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.jacc.2007.12.014","article-title":"Reversal of cardiac dysfunction after long-term expression of SERCA2a by gene transfer in a pre-clinical model of heart failure","volume":"51","author":"Kawase","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"2023112114311611400_ezad371-B23","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1538\/expanim.18-0045","article-title":"The characteristics of a porcine mitral regurgitation model","volume":"67","author":"Li","year":"2018","journal-title":"Exp Anim"},{"key":"2023112114311611400_ezad371-B24","first-page":"713","article-title":"A model of ischemic mitral regurgitation in pigs with three-dimensional echocardiographic assessment","volume":"23","author":"Minakawa","year":"2014","journal-title":"J Heart Valve Dis"},{"key":"2023112114311611400_ezad371-B25","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s12265-017-9751-3","article-title":"A Swine model of percutaneous intracoronary ethanol induced acute myocardial infarction and ischemic mitral regurgitation","volume":"10","author":"Shi","year":"2017","journal-title":"J Cardiovasc Transl Res"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezad371\/53267819\/ezad371.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/64\/5\/ezad371\/53665226\/ezad371.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/64\/5\/ezad371\/53665226\/ezad371.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T22:43:14Z","timestamp":1700606594000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezad371\/7407345"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezad371","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11,1]]},"published":{"date-parts":[[2023,11,1]]},"article-number":"ezad371"}}