Biomechanical Assessment of Tricuspid Regurgitation Using Experimental and Computational Approaches

Functional Tricuspid Regugitation (FTR) accounts for over 80% of all incidences of tricuspid regurgitation (TR) and affects over 1.6 million Americans. The current gold standard treatment approach is implantation of an annuloplasty ring; however, due to late diagnosis, many patients are deemed as too high risk for surgery and only 1% of such patients receive surgical intervention every year. Several percutaneous approaches are under development and undergoing human subject testing in compassionate uses cases, but their mechanical effects on the tricuspid apparatus are currently unknown and may provide valuable information regarding device durability and tissue remodeling. The twofold objective of this study was therefore to characterize the mechanics of the right ventricle (RV) and of TR repair and develop patient-specific computational models of the percutaneous and surgical approaches in order to better understand and compare the mechanics of these methodologies on TR patients. This study was divided into two aims: in Aim 1, the mechanical properties of right heart tissues in human patients were characterized and an experimental replication of the percutaneous bicuspidization technique was developed to quantify the mechanics and geometry of the cinching techniques on these same hearts. In Aim 2, this technique was applied to computational models for patient-specific surgical planning through: (a) the development and validation a computational model of the cinching experiment, and (b) applying the newly developed model to real TR patients by simulating the surgical and percutaneous approaches for mechanical investigation. It is expected that the results of these studies may serve to inform further TR device design and development and offer mechanical explanations for observed post-procedural outcomes.Ph.D