Suture Dehiscence in the Tricuspid Annulus: An Ex Vivo Analysis of Tissue Strength and Composition

Abstract

The clinical predominance of suture dehiscence at the septal annulus, despite its greater ex vivo holding strength, suggests either adverse suture placement techniques in this region or asymmetric tensile loading after implantation. This issue highlights the need to optimize implantation techniques and to carefully assess anchor security in existing and next-generation FTR corrective devices.

Invited Commentary

“…A flat rigid ring will dehisce, as noted in the randomized trial referenced in this article and as I experienced. This study by Paul and colleagues [1] also confirms a clinical observation: the septal leaflet holds sutures best (there is more collagen). Owing to the conduction system, corresponding to the open part in most rings, the surgeon can place sutures only about halfway across the septal leaflet (position 6 in this study).…”

Beating heart technique in tricuspid valve replacement among patients which have a TAPSE index lower than 15 mm

“…In a beating heart, tricuspid valve environment decreases by 19% and tricuspid valve area decreases by 30% during systole, which may cause a reasonable shearing force improvement on posterior annulus resulting with the dehiscence of prosthetic valve [17][18][19]. On the follow-up, we did not observe any case with dehiscence of the prosthetic valve.…”

Transcatheter pledget‐assisted suture tricuspid annuloplasty (PASTA) to create a double‐orifice valve

“…Mitralign/Trialign (17), Tewksbury, MA). Our technique compares favorably to surgical (“partial thickness”) sutures in ovine tricuspid annulus, with a reported pull-through force of 6.5±2.2N (18). Second, we exchange a traversing guidewire for a permanent suture, by crimping a simple low-profile knot to connect the two.…”

“…The double‐puncture pledget technique resulted in a five‐fold higher pull‐through force compared with a single‐puncture alternative, a strategy used in some investigational technologies (e.g., Mitralign/Trialign , Tewksbury, Massachusetts). Our technique compares favorably to surgical (“partial thickness”) sutures in ovine tricuspid annulus, with a reported pull‐through force of 6.5 ± 2.2N . Second, we exchange a traversing guidewire for a permanent suture, by crimping a simple low‐profile knot to connect the two.…”