Heart Valve Biomechanics: The Frontiers of Modeling Modalities and the Expansive Capabilities of Ex Vivo Heart Simulation

Abstract

The field of heart valve biomechanics is a rapidly expanding, highly clinically relevant area of research. While most valvular pathologies are rooted in biomechanical changes, the technologies for studying these pathologies and identifying treatments have largely been limited. Nonetheless, significant advancements are underway to better understand the biomechanics of heart valves, pathologies, and interventional therapeutics, and these advancements have largely been driven by crucial in silico, ex vivo, and in vivo modeling technologies. These modalities represent cutting-edge abilities for generating novel insights regarding native, disease, and repair physiologies, and each has unique advantages and limitations for advancing study in this field. In particular, novel ex vivo modeling technologies represent an especially promising class of translatable research that leverages the advantages from both in silico and in vivo modeling to provide deep quantitative and qualitative insights on valvular biomechanics. The frontiers of this work are being discovered by innovative research groups that have used creative, interdisciplinary approaches toward recapitulating in vivo physiology, changing the landscape of clinical understanding and practice for cardiovascular surgery and medicine.

Biomechanical analysis of neochordal repair error from diastolic phase inversion of static left ventricular pressurization

“…When pressurizing the LV of an arrested heart, the MV apparatus and subvalvular structures dilate in a state similar to that of diastole when the LV would otherwise be contracting during systole in a beating heart. 12 , 13 More specifically, in vivo, the PMs, which commonly serve as the distal anchor point of the neochordae, move with each heartbeat, translating and rotating relative to the valve annulus, and this movement can be generally characterized as a reduction in the distance between the PM and the valve annulus upon leaflet coaptation. 14 , 15 On the contrary, static pressurization simulates the opposite as it causes the LV to dilate, moving the PMs further away from the annulus upon leaflet coaptation.…”

Comparative analyses of blood flow through mechanical trileaflet and bileaflet aortic valves

“…Such research is commonly conducted by means of in silico modelling. An alternative, although more expensive, might be ex vivo modelling [31]. Such a methodology was applied in the study of a novel trilea et valve [15,32].…”

Design and Analysis of Prosthetic Heart Valves and Assessing the Effects of Leaflet Design on the Mechanical Attributes of the Valves

“…Kerr and Gourlay (2020) investigated an expandable valve design using FSI simulations. Park et al (2021) reviewed various study techniques of the prosthetic heart valves and categorized them. Nestola et al (2021) proposed an FSI model to study the dynamic behavior of the bioprosthetic heart valves with the goal of optimizing the stress distribution on the leaflets.…”