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How Local Annular Force and Collagen Density Govern Mitral Annuloplasty Ring Dehiscence Risk
Eric L Pierce1, Andrew W Siefert1, Deborah M Paul1
1The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
The Annals of Thoracic Surgery
|May 3, 2016
Summary
Mitral annuloplasty ring dehiscence risk is higher posteriorly due to weaker tissue, despite lower cyclic forces. Sutures near trigones are also less secure, highlighting the importance of collagen density for mitral valve repair success.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Cardiac Anatomy
Background:
- Annuloplasty ring dehiscence is a known cause of mitral valve repair failure.
- Understanding the mechanisms behind dehiscence is crucial for prevention strategies.
Purpose of the Study:
- To investigate the biomechanical factors contributing to suture dehiscence in mitral annuloplasty.
- To identify specific anatomical regions of the mitral annulus with higher risk of dehiscence.
Main Methods:
- An ovine model was used to measure cyclic force (FC) on sutures during cardiac cycles at varying left ventricular pressures (LVPmax).
- Suture pullout testing was performed on explanted mitral annuli to assess holding strength.
- Collagen density at suture sites was analyzed using two-photon excitation fluoroscopy.
Main Results:
- Anterior sutures experienced higher cyclic forces than posterior sutures.
- Posterior mitral annular tissue exhibited significantly lower suture holding strength compared to anterior tissue.
- The margin of safety against suture pullout strongly correlated with local collagen density.
Conclusions:
- Weaker posterior mitral annular tissue, with reduced collagen content, increases the risk of dehiscence.
- Sutures placed near the trigones are less secure due to lower collagen and higher rigidity.
- Inter-trigonal tissue represents a superior anchor, informing future prosthesis design and implantation techniques.
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