# Modified Clover Technique Using Automated Suture Placement and Securing Technology in a Passive Beating Heart Model

## TL;DR

A modified clover technique using automated suturing significantly reduces tricuspid regurgitation in a pig heart model, showing promise for endoscopic valve surgery.

## Contribution

The study introduces a modified clover technique with automated suturing for tricuspid repair in a passive beating heart model.

## Key findings

- The modified clover technique reduced regurgitant volume to 12 ± 3.9 mL, significantly lower than standard ring annuloplasty.
- Combining the modified clover with ring annuloplasty achieved the lowest regurgitant volume of 7.6 ± 3.4 mL.
- The technique shows potential for facilitating totally endoscopic tricuspid valve repair.

## Abstract

Tricuspid regurgitation (TR) is a prevalent finding in echocardiography and in case of severe disease is associated with impaired patient outcome. Clover repair offers a surgical solution that can be applied for the treatment of primary and secondary TR. An ex vivo passive beating porcine heart model was created to test a modified clover technique using automated suturing devices and to compare this approach to standard ring annuloplasty. Secondary TR was induced in 10 porcine hearts and the backflow of fluid was assessed. The primary endpoint of this study was regurgitant volume measured in mL at the site right atrial cannula. The baseline regurgitation was 43.3 ± 10.8 mL. The mean regurgitant volume was significantly reduced after all repair procedures to 22.2 ± 5.9 mL with isolated ring annuloplasty, 12 ± 3.9 mL with the modified clover, and 7.6 ± 3.4 mL with the combined procedure (p < 0.0001). The modified clover technique shows how to effectively reduce TR in an ex vivo model. This method may be suitable to facilitate tricuspid repair, especially for totally endoscopic valve surgery.