Mitral annuloplasty ring suture forces: Impact of surgeon, ring, and use conditions

Abstract

Mitral annuloplasty suture loading is influenced by ring type, ring-annulus sizing, suture position, and surgeon, suggesting that reports of dehiscence may not be merely a series of isolated errors. When compared with forces known to cause suture dehiscence, these in vivo suture loading data aid in establishing potential targets for reducing the occurrence of ring dehiscence.

Commentary: Another step in the journey toward the “perfect” mitral valve repair

“…Despite providing overall reduced suture forces, however, the semirigid ring showed no significant reduction on the anterior region and especially on the 1-o'clock and 11o'clock positions. This is a notable outcome, considering that in their previous works 2,3 this group has emphasized the higher loading of the anterior annulus relative to the posterior and commissural part, and it is particularly important considering that the interaction of ring type and suture region significantly affects the overall forces generated. This study has the limitations associated with most animal model studies, and it has been conducted only in a small sample of healthy animals.…”

“…Their research team has an established experience with this type of model and has previously reported similar animal studies that investigated mitral ring suture forces. 2,3 In their previous reports, they found that the suture loading is influenced by ring type, ring annular size, and suture positions, and that dehiscence might not be related merely to isolated surgical errors. These findings are very important, and with this new study, Ncho and colleagues 1 have gone even further by developing and creating a new semirigid 3-dimensionally printed mitral valve ring.…”

Heart Valve Biomechanics: The Frontiers of Modeling Modalities and the Expansive Capabilities of Ex Vivo Heart Simulation

“…In a series of studies, researchers developed and utilized a mitral annulus force transducer that measures in-plane radial forces resulting from annular contraction (122). This has led to several lines of experimentation aimed at characterizing mitral annular dynamics in native, pathological, and repair scenarios (123)(124)(125)(126)(127)(128)(129). Another instrumented, in vivo biomechanics study translates the fiber Bragg grating neochordae, which directly measures chordal forces, for in vivo use.…”

Cardiac surgeons: Are we too tight?

“…This study by Pierce and colleagues 1 in this issue of the Journal is a novel one. We have seen limited work in the area of measuring technical suturing performance such as this.…”