Mitral Annuloplasty Ring Suture Forces: Impact of Surgeon, Ring, and Use Conditions

Abstract Objective – To quantify the effect of ring type, ring-annulus sizing, suture position, and surgeon on the forces required to tie-down and constrain a mitral annuloplasty ring to a beating heart. Methods – Physio or Profile3D annuloplasty rings were instrumented with suture force transducers...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2018-01, Vol.155 (1), p.131-139.e3
Main Authors: Pierce, Eric L., BS, Bloodworth, Charles H., BS, Siefert, Andrew W., PhD, Easley, Thomas F., MS, Takayama, Tetsushi, MD, Kawamura, Tomonori, MD, Gorman, Robert C., MD, Gorman, Joseph H., MD, Yoganathan, Ajit P., PhD
Format: Article
Language:English
Subjects:
annuloplasty
Cardiothoracic Surgery
dehiscence
force
medical device design
mitral valve
recurrent, regurgitation
suture
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Summary:Abstract Objective – To quantify the effect of ring type, ring-annulus sizing, suture position, and surgeon on the forces required to tie-down and constrain a mitral annuloplasty ring to a beating heart. Methods – Physio or Profile3D annuloplasty rings were instrumented with suture force transducers and implanted in ovine subjects (N=23). Tie-down forces and cyclic contractile forces were recorded and analyzed at ten suture positions and at three levels of increasing peak left ventricular pressure. Results – Across all conditions, tie-down force was 2.7±1.4N; cyclic contractile force was 2.0±1.2N. Tie-down force was not meaningfully affected by any factor except surgeon. Significant differences in overall and individual tie-down forces were observed between the two primary implanting surgeons. No other factors were observed to significantly affect tie-down force. Contractile suture forces were significantly reduced by ring-annulus true-sizing. This was driven almost exclusively by Physio cases, and by reduction along the anterior aspect, where dehiscence is less common clinically. Contractile suture forces did not differ significantly between ring types. However, when undersizing, Profile3DTM forces were significantly more uniform around the annular circumference. A suture’s tie-down force did not correlate to its eventual contractile force. Conclusions – Mitral annuloplasty suture loading is influenced by ring type, ring-annulus sizing, suture position, and surgeon, suggesting reports of dehiscence may not be merely a series of isolated errors. When compared to forces known to cause suture dehiscence, these in vivo suture loading data aid in establishing potential targets for reducing the occurrence of ring dehiscence.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2017.06.036