Semi-rigid mitral annuloplasty rings improve myocardial stress adaptation compared to rigid rings: insights from in vitro and in vivo experimental evaluation†

Søren Nielsen Skov; Diana Mathilde Røpcke Lyager; Marcell Juan Tjørnild; Christine Ilkjær; Jonas Rasmussen; Hans Nygaard; Morten Olgaard Jensen; Sten Lyager Nielsen

doi:10.1093/ejcts/ezw421

Semi-rigid mitral annuloplasty rings improve myocardial stress adaptation compared to rigid rings: insights from in vitro and in vivo experimental evaluation†

Søren Nielsen Skov, Diana Mathilde Røpcke Lyager, Marcell Juan Tjørnild, Christine Ilkjær, Jonas Rasmussen, Hans Nygaard, Morten Olgaard Jensen, Sten Lyager Nielsen

Institut for Klinisk Medicin - Hjerte-, Lunge- og Karkirurgi

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

4 Citationer (Scopus)

Abstract

OBJECTIVES: Investigate myocardial stress adaptation and remodelling capacity of a rigid and semi-rigid mitral annuloplasty ring. METHODS: The annuloplasty rings were characterized in vitro in a mechanical setup with tensile and compressive forces from 0 to 3 N. The rings were tested with and without fixation of the ring to imitate the effect of annular implantation. In vivo measurements were performed with 21 porcine animals randomized into: A no ring group, a rigid ring group (Classic Annuloplasty RingTM, Edwards Lifesciences) and a semi-rigid ring group (Physio I Annuloplasty Ring, Edwards Lifesciences). The rings were implanted together with a force transducer and sonomicrometry was used for geometry measurements. RESULTS: The flexibility range of the semi-rigid ring was 7.6 and 2.4mm in the septal-lateral and commissural direction, respectively. With fixation the flexibility was reduced to 1.0 and 0.6 mm, similar to the rigid ring without fixation. In vivo measurements indicated that the rigid and semi-rigid rings equally restrict the annular movement. Septal-lateral flexibility of the semi-rigid ring was not observed. Both rings induced force absorption in the ring and sutures due to the annular fixation. The absorbed forces were significantly lower for the semi-rigid ring in the posterior segment and septal-lateral direction. CONCLUSIONS: This study demonstrates the importance of correct fixation when characterizing annuloplasty rings. The annular movement of the semi-rigid ring was similar to the rigid ring when implanted at the mitral annulus as confirmed in vitro. Despite this the semirigid ring demonstrated a favourable stress adaptation which could potentially decrease the risk of ring dehiscence.

Originalsprog	Engelsk
Artikelnummer	ezw421
Tidsskrift	European Journal of Cardio-Thoracic Surgery
Vol/bind	51
Nummer	5
Sider (fra-til)	836-843
Antal sider	8
ISSN	1010-7940
DOI	https://doi.org/10.1093/ejcts/ezw421
Status	Udgivet - 2017

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10.1093/ejcts/ezw421

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Skov, S. N., Lyager, D. M. R., Tjørnild, M. J., Ilkjær, C., Rasmussen, J., Nygaard, H., Jensen, M. O., & Nielsen, S. L. (2017). Semi-rigid mitral annuloplasty rings improve myocardial stress adaptation compared to rigid rings: insights from in vitro and in vivo experimental evaluation†. European Journal of Cardio-Thoracic Surgery, 51(5), 836-843. Artikel ezw421. https://doi.org/10.1093/ejcts/ezw421

@article{e67769197b50423ca3e050437163d015,

title = "Semi-rigid mitral annuloplasty rings improve myocardial stress adaptation compared to rigid rings: insights from in vitro and in vivo experimental evaluation†",

abstract = "OBJECTIVES: Investigate myocardial stress adaptation and remodelling capacity of a rigid and semi-rigid mitral annuloplasty ring. METHODS: The annuloplasty rings were characterized in vitro in a mechanical setup with tensile and compressive forces from 0 to 3 N. The rings were tested with and without fixation of the ring to imitate the effect of annular implantation. In vivo measurements were performed with 21 porcine animals randomized into: A no ring group, a rigid ring group (Classic Annuloplasty RingTM, Edwards Lifesciences) and a semi-rigid ring group (Physio I Annuloplasty Ring, Edwards Lifesciences). The rings were implanted together with a force transducer and sonomicrometry was used for geometry measurements. RESULTS: The flexibility range of the semi-rigid ring was 7.6 and 2.4mm in the septal-lateral and commissural direction, respectively. With fixation the flexibility was reduced to 1.0 and 0.6 mm, similar to the rigid ring without fixation. In vivo measurements indicated that the rigid and semi-rigid rings equally restrict the annular movement. Septal-lateral flexibility of the semi-rigid ring was not observed. Both rings induced force absorption in the ring and sutures due to the annular fixation. The absorbed forces were significantly lower for the semi-rigid ring in the posterior segment and septal-lateral direction. CONCLUSIONS: This study demonstrates the importance of correct fixation when characterizing annuloplasty rings. The annular movement of the semi-rigid ring was similar to the rigid ring when implanted at the mitral annulus as confirmed in vitro. Despite this the semirigid ring demonstrated a favourable stress adaptation which could potentially decrease the risk of ring dehiscence.",

keywords = "Annuloplasty ring dehiscence, Mitral annular stress adaptation, Mitral valve, Mitral valve annuloplasty, Semi-rigid annuloplasty ring",

author = "Skov, {S{\o}ren Nielsen} and Lyager, {Diana Mathilde R{\o}pcke} and Tj{\o}rnild, {Marcell Juan} and Christine Ilkj{\ae}r and Jonas Rasmussen and Hans Nygaard and Jensen, {Morten Olgaard} and Nielsen, {Sten Lyager}",

year = "2017",

doi = "10.1093/ejcts/ezw421",

language = "English",

volume = "51",

pages = "836--843",

journal = "European Journal of Cardio-Thoracic Surgery",

issn = "1010-7940",

publisher = "Oxford University Press",

number = "5",

}

Skov, SN, Lyager, DMR, Tjørnild, MJ , Ilkjær, C , Rasmussen, J, Nygaard, H, Jensen, MO & Nielsen, SL 2017, 'Semi-rigid mitral annuloplasty rings improve myocardial stress adaptation compared to rigid rings: insights from in vitro and in vivo experimental evaluation†', European Journal of Cardio-Thoracic Surgery, bind 51, nr. 5, ezw421, s. 836-843. https://doi.org/10.1093/ejcts/ezw421

Semi-rigid mitral annuloplasty rings improve myocardial stress adaptation compared to rigid rings: insights from in vitro and in vivo experimental evaluation†. / Skov, Søren Nielsen; Lyager, Diana Mathilde Røpcke; Tjørnild, Marcell Juan et al.
I: European Journal of Cardio-Thoracic Surgery, Bind 51, Nr. 5, ezw421, 2017, s. 836-843.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Semi-rigid mitral annuloplasty rings improve myocardial stress adaptation compared to rigid rings

T2 - insights from in vitro and in vivo experimental evaluation†

AU - Skov, Søren Nielsen

AU - Lyager, Diana Mathilde Røpcke

AU - Tjørnild, Marcell Juan

AU - Ilkjær, Christine

AU - Rasmussen, Jonas

AU - Nygaard, Hans

AU - Jensen, Morten Olgaard

AU - Nielsen, Sten Lyager

PY - 2017

Y1 - 2017

N2 - OBJECTIVES: Investigate myocardial stress adaptation and remodelling capacity of a rigid and semi-rigid mitral annuloplasty ring. METHODS: The annuloplasty rings were characterized in vitro in a mechanical setup with tensile and compressive forces from 0 to 3 N. The rings were tested with and without fixation of the ring to imitate the effect of annular implantation. In vivo measurements were performed with 21 porcine animals randomized into: A no ring group, a rigid ring group (Classic Annuloplasty RingTM, Edwards Lifesciences) and a semi-rigid ring group (Physio I Annuloplasty Ring, Edwards Lifesciences). The rings were implanted together with a force transducer and sonomicrometry was used for geometry measurements. RESULTS: The flexibility range of the semi-rigid ring was 7.6 and 2.4mm in the septal-lateral and commissural direction, respectively. With fixation the flexibility was reduced to 1.0 and 0.6 mm, similar to the rigid ring without fixation. In vivo measurements indicated that the rigid and semi-rigid rings equally restrict the annular movement. Septal-lateral flexibility of the semi-rigid ring was not observed. Both rings induced force absorption in the ring and sutures due to the annular fixation. The absorbed forces were significantly lower for the semi-rigid ring in the posterior segment and septal-lateral direction. CONCLUSIONS: This study demonstrates the importance of correct fixation when characterizing annuloplasty rings. The annular movement of the semi-rigid ring was similar to the rigid ring when implanted at the mitral annulus as confirmed in vitro. Despite this the semirigid ring demonstrated a favourable stress adaptation which could potentially decrease the risk of ring dehiscence.

AB - OBJECTIVES: Investigate myocardial stress adaptation and remodelling capacity of a rigid and semi-rigid mitral annuloplasty ring. METHODS: The annuloplasty rings were characterized in vitro in a mechanical setup with tensile and compressive forces from 0 to 3 N. The rings were tested with and without fixation of the ring to imitate the effect of annular implantation. In vivo measurements were performed with 21 porcine animals randomized into: A no ring group, a rigid ring group (Classic Annuloplasty RingTM, Edwards Lifesciences) and a semi-rigid ring group (Physio I Annuloplasty Ring, Edwards Lifesciences). The rings were implanted together with a force transducer and sonomicrometry was used for geometry measurements. RESULTS: The flexibility range of the semi-rigid ring was 7.6 and 2.4mm in the septal-lateral and commissural direction, respectively. With fixation the flexibility was reduced to 1.0 and 0.6 mm, similar to the rigid ring without fixation. In vivo measurements indicated that the rigid and semi-rigid rings equally restrict the annular movement. Septal-lateral flexibility of the semi-rigid ring was not observed. Both rings induced force absorption in the ring and sutures due to the annular fixation. The absorbed forces were significantly lower for the semi-rigid ring in the posterior segment and septal-lateral direction. CONCLUSIONS: This study demonstrates the importance of correct fixation when characterizing annuloplasty rings. The annular movement of the semi-rigid ring was similar to the rigid ring when implanted at the mitral annulus as confirmed in vitro. Despite this the semirigid ring demonstrated a favourable stress adaptation which could potentially decrease the risk of ring dehiscence.

KW - Annuloplasty ring dehiscence

KW - Mitral annular stress adaptation

KW - Mitral valve

KW - Mitral valve annuloplasty

KW - Semi-rigid annuloplasty ring

UR - http://www.scopus.com/inward/record.url?scp=85019153247&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezw421

DO - 10.1093/ejcts/ezw421

M3 - Journal article

C2 - 28175268

SN - 1010-7940

VL - 51

SP - 836

EP - 843

JO - European Journal of Cardio-Thoracic Surgery

JF - European Journal of Cardio-Thoracic Surgery

IS - 5

M1 - ezw421

ER -

Semi-rigid mitral annuloplasty rings improve myocardial stress adaptation compared to rigid rings: insights from in vitro and in vivo experimental evaluation†

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