Mitral annuloplasty ring flexibility preferentially reduces posterior suture forces.
Mitral annuloplasty ring flexibility preferentially reduces posterior suture forces.
复制标题
二尖瓣环成形术环的灵活性优先减少后缝合力。
DOI：
10.1016/j.jbiomech.2018.04.043
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发表时间：
2018
影响因子：
2.4
通讯作者：
Yoganathan,AjitP
中科院分区：
文献类型：
--
作者：
Pierce,EricL;Bloodworth4th,CharlesH;Imai,Akito;Okamoto,Keitaro;Saito,Yoshiaki;Gorman,RobertC;Gorman3rd,JosephH;Yoganathan,AjitP
二尖瓣环成形术是矫正二尖瓣返流的常用方法。市场上可买到的环在尺寸和材料特性上各不相同。环状成形术环状缝合从天然环状裂开是一种灾难性但知之甚少的现象，已在不同类型的环状结构中报道。认识到缝线通常从结构较弱的后环裂开，我们的团队正在进行一项多部分研究，以寻找影响心脏跳动中后环缝合的作用力的环设计参数。在这里，我们报告了环的刚性对缝合力的影响。测量使用定制的力传感器，连接到瓣环成形术环上，并通过标准手术程序植入正常绵羊受试者体内。测试的环包括半刚性物理(爱德华兹生命科学)和匹配几何的刚性和柔性原型。使用弹性环后，前部缝合线的受力无明显差异(刚性：1.95 ± 0.96 N，半刚性：1.76 ± 1.19 N；挠性：1.04 ± 0.63 N；p <； 0.001)。前后方FC的比例随着柔韧性的增加而增加(p <； 0.001)，当使用弹性环时，后方力量需要更多的时间才能达到峰值(p <； 0.001)。这表明，更坚硬的环可以在缝合网络周围实现更快/更完整的力平衡，将更高的前力传递到较弱的后部组织。对于需要环刚性的二尖瓣环成形术，我们提出了环设计的概念，潜在地破坏了这种力的传递，并改善了缝合线的保持。
Annuloplasty ring repair is a common procedure for the correction of mitral valve regurgitation. Commercially available rings vary in dimensions and material properties. Annuloplasty ring suture dehiscence from the native annulus is a catastrophic yet poorly understood phenomenon that has been reported across ring types. Recognizing that sutures typically dehisce from the structurally weaker posterior annulus, our group is conducting a multi-part study in search of ring design parameters that influence forces acting on posterior annular sutures in the beating heart. Herein, we report the effect of ring rigidity on suture forces. Measurements utilized custom force sensors, attached to annuloplasty rings and implanted in normal ovine subjects via standard surgical procedure. Tested rings included the semi-rigid Physio (Edwards Lifesciences) and rigid and flexible prototypes of matching geometry. While no significant differences due to ring stiffness existed for sutures in the anterior region, posterior forces were significantly reduced with use of the flexible ring (rigid: 1.95 ± 0.96 N, semi-rigid: 1.76 ± 1.19 N, flexible: 1.04 ± 0.63 N; p < 0.001). The ratio of anterior to posterior FCscaled positively with increasing flexibility (p < 0.001), and posterior forces took more time to reach their peak load when a flexible ring was used (p < 0.001). This suggests a more rigid ring enables more rapid/complete force equilibration around the suture network, transferring higher anterior forces to the weaker posterior tissue. For mitral annuloplasties requiring ring rigidity, we propose a ring design concept to potentially disrupt this force transfer and improve suture retention.