Christine Ilkjaer1,2,4, Diana M. Ropcke1,2, Søren N. Skov1,2, Marcell J. Tjornild1,2, Anders Vibaek2, Morten O. Jensen3, Sten L. Nielsen1,21Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark
2Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
3Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
4Electronic correspondence: email@example.com
Background and aim of the study: Stentless porcine extracellular matrix (ECM) tricuspid tube-grafts have been developed for tricuspid valve reconstruction. The ECM acts as a degradable scaffold, allowing ingrowth of the recipient’s own cells over time. Concern remains that tensile stresses of the tissue may compromise durability. The study aim was to characterize and compare the effect of a remodeling annuloplasty ring on a tube-graft and on a native porcine tricuspid valve.
Methods: Twelve pigs (body weight 65 kg) were randomized to ECM tube-graft implantation (n = 6) versus control (n = 6). Thirteen piezoelectric sonomicrometry crystals were inserted in the valve apparatus, and a force transducer was inserted in the anterior papillary muscle (APM). Data collection, including echocardiography, was performed before and after insertion of a remodeling annuloplasty ring.Results: Implantation of the tube grafts resulted in a 33 ±
6% reduction of tricuspid annulus circumference compared to the native tricuspid valve. Implantationof a physiological ring did not further reduce the annular dimensions significantly. Ring implantation fixated systolic configuration of the annulus and remodeled the reconstructed annulus from round to ellipsoid. The anterior annular segment was stretched (p <0.01) with a concomitant rise in APM tension of 0.3 ± 0.5 N (p <0.01).
Conclusion: Although a remodeling ring annuloplasty did not further reduce the annular dimensions in ECM valves, it remodeled the tricuspid annulus into a more elliptical shape mimicking the native systolic configuration.
Presented at the 26th Annual Meeting of the Scandinavian Society for Research in Cardiothoracic Surgery, 11th-13th February 2016, Geilo, Norway
The Journal of Heart Valve Disease 2018-19;27:259-268
|Functional and Biomechanical Effects of Ring Annuloplasty on Tissue-Engineered Tricuspid Tube-Graft|
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