ArticleThe Annals of thoracic surgery2016
How Local Annular Force and Collagen Density Govern Mitral Annuloplasty Ring Dehiscence Risk.
Article in The Annals of thoracic surgery, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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14 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2021Pooled it
- Ring Dehiscence From Right Fibrous Trigone Misidentification.JACC. Case reports · 2026Article
- Automated Suture Securing Technology in Mitral Valve Surgery: A Strategy to Reduce Prosthetic Dehiscence?European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026Article
- Evaluating Novel Annuloplasty Ring Designs in a Pathophysiological Animal Model.Annals of thoracic surgery short reports · 2025Article
- Characterisation of global and regional mitral annular strains in an acute porcine model.Interdisciplinary cardiovascular and thoracic surgery · 2024Article
- Utilization of Engineering Advances for Detailed Biomechanical Characterization of the Mitral-Ventricular Relationship to Optimize Repair Strategies: A Comprehensive Review.Bioengineering (Basel, Switzerland) · 2023Review
- How Strong Can We Pull? Critical Thresholds for Traction Forces on the Aortic Annulus: Measurements on Fresh Porcine Hearts.Medicina (Kaunas, Lithuania) · 2022Article
- Successful mitral valve-in-ring repair of mitral annuloplasty ring dehiscence causing severe mitral regurgitation: a case report.European heart journal. Case reports · 2021Article
- Very long-term outcomes of twisted auto-pericardial mitral annuloplasty.General thoracic and cardiovascular surgery · 2020Article
- Optimized mitral annuloplasty ring design reduces loading in the posterior annulus.The Journal of thoracic and cardiovascular surgery · 2020Article
- Suture dehiscence and collagen content in the human mitral and tricuspid annuli.Biomechanics and modeling in mechanobiology · 2019Article
- Novel In Vitro Test Systems and Insights for Transcatheter Mitral Valve Design, Part II: Radial Expansion Forces.Annals of biomedical engineering · 2019Article
- Durability of mitral valve repair for degenerative mitral regurgitation: is it gold all that glitters?Annals of translational medicine · 2018Article
- Mitral annuloplasty ring suture dehiscence: In search of more robust techniques.The Journal of thoracic and cardiovascular surgery · 2016Article
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Authors and funding
12 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundAnnuloplasty ring dehiscence is a well described mode of mitral valve repair failure. Defining the mechanisms underlying dehiscence may facilitate its prevention.
methodsFactors that govern suture dehiscence were examined with an ovine model. After undersized ring annuloplasty in live animals (n = 5), cyclic force (FC) that acts on sutures during cardiac contraction was measured with custom transducers. FC was measured at ten suture positions, throughout cardiac cycles with peak left ventricular pressure (LVPmax) of 100, 125, and 150 mm Hg. Suture pullout testing was conducted on explanted mitral annuli (n = 12) to determine suture holding strength at each position. Finally, relative collagen density differences at suture sites around the annulus were assessed by two-photon excitation fluoroscopy.
resultsAnterior FC exceeded posterior FC at each LVPmax (eg, 2.8 ± 1.3 N versus 1.8 ± 1.2 N at LVPmax = 125 mm Hg, p < 0.01). Anterior holding strength exceeded posterior holding strength (6.4 ± 3.6 N versus 3.9 ± 1.6 N, p < 0.0001). On the basis of FC at LVPmax of 150 mm Hg, margin of safety before suture pullout was vastly higher between the trigones (exclusive) versus elsewhere (4.8 ± 0.9 N versus 1.9 ± 0.5 N, p < 0.001). Margin of safety exhibited strong correlation to collagen density (R(2) = 0.947).
conclusionsDespite lower cyclic loading on posterior sutures, the weaker posterior mitral annular tissue creates higher risk of dehiscence, apparently because of reduced collagen content. Sutures placed atop the trigones are less secure than predicted, because of a combination of reduced collagen and higher overall rigidity in this region. These findings highlight the inter-trigonal tissue as the superior anchor and have implications on the design and implantation techniques for next-generation mitral prostheses.
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