Valvular heart disease is a highly prevalent and increasingly clinically addressed problem worldwide, with evolving treatment guidelines supporting earlier intervention as well as valve repair over replacement when possible. Most valvular pathologies are rooted in biomechanical changes, such as the nuanced interplay between tissue degeneration, valve kinematics, and cardiac function. However, advances in repair techniques have progressed in the clinical arena primarily based upon anatomic and physiologic premises. Thus, by using biomechanical engineering tools to investigate valvular disease and analyze treatments, quantitative data can be harnessed to optimize surgical repair techniques and devices. An innovative left heart simulator was designed and produced to study the mechanics of mitral and aortic valve specimens throughout the cardiac cycle. This ex vivo analysis enables rapid and safe testing of surgical operations and offers new insight into the nuances of valvular disease and repair.

This dissertation first details significant advancements to heart simulator technology:​ the development of low-profile chordal strain gauges, coupled image-guided robots to replicate papillary muscle motion, and two mitral annular dilation devices. Building on this heart simulator technology foundation, novel disease models were developed and analyzed:​ Barlow’s mitral valve disease, aortic regurgitation from cusp prolapse, and bicuspid aortic valve disease. Finally, facilitated by the simulator and modeling advancements, I analyzed contemporary operative techniques and devices:​ valve-sparing root replacement, posterior ventricular anchoring neochordal repair, and transapical neochordal repair devices. A novel artificial papillary muscle device was also designed and tested to integrate with current minimally invasive mitral valve repair devices under trials. The research outlined herein has resulted in a significant clinical impact on aortic and mitral valve repair, and this work will continue to serve as a foundation for future investigations of clinical therapies for valve disease that can be rapidly translated to intraoperative patient care.