Percutaneous Closure of Mitral Paravalvular Leak

Jones-Haywood, Mandisa Maia; Combs, Craig; Pu, Min; Gandhi, Sanjay; Dhawan, Richa; Tempe, Deepak K

doi:10.1053/j.jvca.2012.07.006

Cited by 11 publications

(4 citation statements)

References 36 publications

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“…[9, 10, 12] Yet, the factors influencing its occurrence remain unclear. One clue comes from Spratt et al, who measured the total force necessary for complete ring dehiscence ex vivo , and observed increased strength using a flexible ring with a running suture.…”

mentioning

confidence: 99%

“…[13] Still, no data have identified why sutures more commonly dehisce from the posterior aspect of the annulus. [7–9, 12] Further uncertainty surrounds the contributions of suture technique, device size and shape, hemodynamic conditions, annular microstructure, or combinations thereof. [14–16] Developing a comprehensive understanding of these potential factors is an important step toward reducing the risk of device dehiscence, establishing optimal pre-clinical regulatory standards for future MV devices, and advancing implantation procedures.…”

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confidence: 99%

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How Local Annular Force and Collagen Density Govern Mitral Annuloplasty Ring Dehiscence Risk

Pierce

Siefert

Paul

et al. 2016

The Annals of Thoracic Surgery

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Background Annuloplasty ring dehiscence is a well described mechanism of mitral valve repair failure. Defining the mechanisms underlying dehiscence may facilitate its prevention. Methods Factors governing suture dehiscence were examined using an ovine model. Following undersized ring annuloplasty in live animals (N=5), Cyclic Force (FC) acting on sutures during cardiac contraction were measured using custom transducers. FC was measured at 10 suture positions, throughout cardiac cycles with peak left ventricular pressure (LVPmax) of 100, 125, and 150mmHg. 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. Results Anterior FC exceeded posterior at each LVPmax (e.g. 2.8±1.3 vs. 1.8±1.2N at LVPmax=125mmHg, p<0.01). Anterior holding strength exceeded posterior (6.4±3.6 vs. 3.9±1.6N, p<0.0001). Based on FC at LVPmax=150mmHg, margin of safety before suture pullout was vastly higher between the trigones (exclusive) versus elsewhere (4.8±0.9 versus 1.9±0.5N, p<0.001). Margin of safety exhibited strong correlation to collagen density (R2=0.947). Conclusions Despite lower cyclic loading on posterior sutures, the weaker posterior mitral annular tissue creates higher risk of dehiscence, apparently due to reduced collagen content. Sutures placed atop the trigones are less secure than predicted, due to 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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confidence: 99%

mentioning

confidence: 99%

How Local Annular Force and Collagen Density Govern Mitral Annuloplasty Ring Dehiscence Risk

Pierce

Siefert

Paul

et al. 2016

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…2,3 Recurrent MR is associated with significantly reduced survival rates, sometimes requiring repeat hospitalization and interventions. 3,4 A recognized cause of recurrent MR after annuloplasty is ring dehiscence, [5][6][7] and is estimated to underlie 13% to 42% of reoperations for failed annuloplasty repairs. [8][9][10] This phenomenon occurs when the sutures that attach the annuloplasty ring to the mitral annulus pull out from the tissue.…”

Section: Perspectivementioning

confidence: 99%

“…[8][9][10] This phenomenon occurs when the sutures that attach the annuloplasty ring to the mitral annulus pull out from the tissue. Its consequences are often severe, and can include device migration, 6 embolization, endocarditis, 7 and increased patient morbidity. Reports have indicated dehiscence to be more common along the posterior annulus.…”

Section: Perspectivementioning

confidence: 99%