Mitral annuloplasty ring flexibility preferentially reduces posterior suture forces

Annuloplasty ring repair is a common procedure for the correction of mitral valve regurgitation. Commercially available rings vary in dimensions and material properties. Annuloplasty ring suture dehiscence from the native annulus is a catastrophic yet poorly understood phenomenon that has been repor...

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Bibliographic Details
Published in:Journal of biomechanics 2018-06, Vol.75, p.58-66
Main Authors: Pierce, Eric L., Bloodworth, Charles H., Imai, Akito, Okamoto, Keitaro, Saito, Yoshiaki, Gorman, Robert C., Gorman, Joseph H., Yoganathan, Ajit P.
Format: Article
Language:English
Subjects:
Animals
Annuli
Annuloplasty
Dehiscence
Design parameters
Device design
Flexibility
Geometry
Heart rate
Heart valve
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Material properties
Mitral
Mitral valve
Mitral Valve Annuloplasty
Mitral Valve Insufficiency
Peak load
Postoperative Complications
Prosthesis Design
Regurgitation
Rigidity
Rings (mathematics)
Sensors
Sheep
Stiffness
Suture dehiscence
Sutures
Vascular implants
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Summary:Annuloplasty ring repair is a common procedure for the correction of mitral valve regurgitation. Commercially available rings vary in dimensions and material properties. Annuloplasty ring suture dehiscence from the native annulus is a catastrophic yet poorly understood phenomenon that has been reported across ring types. Recognizing that sutures typically dehisce from the structurally weaker posterior annulus, our group is conducting a multi-part study in search of ring design parameters that influence forces acting on posterior annular sutures in the beating heart. Herein, we report the effect of ring rigidity on suture forces. Measurements utilized custom force sensors, attached to annuloplasty rings and implanted in normal ovine subjects via standard surgical procedure. Tested rings included the semi-rigid Physio (Edwards Lifesciences) and rigid and flexible prototypes of matching geometry. While no significant differences due to ring stiffness existed for sutures in the anterior region, posterior forces were significantly reduced with use of the flexible ring (rigid: 1.95 ± 0.96 N, semi-rigid: 1.76 ± 1.19 N, flexible: 1.04 ± 0.63 N; p 
ISSN:0021-9290
1873-2380
DOI:10.1016/j.jbiomech.2018.04.043