TY - JOUR

T1 - Functional and Biomechanical Performance of Stentless Extracellular Matrix Tricuspid Tube Graft

T2 - An Acute Experimental Porcine Evaluation

AU - Ropcke, Diana M

AU - Ilkjær, Christine

AU - Skov, Søren N.

AU - Tjørnild, Marcell J

AU - Sørensen, Anders V.

AU - Jensen, Henrik

AU - Jensen, Morten O J

AU - Hjortdal, Vibeke E

AU - Nielsen, Sten L

N1 - Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

PY - 2016/1

Y1 - 2016/1

N2 - BACKGROUND: Stentless porcine extracellular matrix tricuspid tubular valves have been developed for tricuspid valve reconstruction. The purpose of this study was to compare biomechanical and functional performance of native and tube graft valves in an acute porcine model.METHODS: Twenty-two 65-kg pigs were randomized to tube graft or control with native valve preservation. Anterior papillary muscle force was measured with a dedicated force transducer. Microtip pressure catheters were placed in the right atrium and ventricle. Leaflet motion and three-dimensional valve geometry were evaluated using 13 sonomicrometry crystals: six in the tricuspid annulus, one on each leaflet free edge, one on each papillary muscle tip, and one in the right ventricular apex.RESULTS: No regurgitation and no significant differences in intracavitary pressures, annular motion, or leaflet excursion angles were observed after tube graft implantation (p > 0.05). Compared with the native valve, the tricuspid annulus, leaflet orifice area, annular diameters, and the septal segment of the annulus were significantly smaller in the tube graft group (p < 0.05). Maximum anterior papillary muscle force was significantly lower in the tube graft group (p < 0.005). The implantation technique led to an annular circumferential downsizing of 20% ± 17%.CONCLUSIONS: An extracellular matrix tube graft implanted in the tricuspid position produces a competent valve with physiologic performance that, despite downsizing, makes the tube graft an attractive alternative to valve replacement. The downsizing of the implantation should be considered when planning tube graft size and may be potentially beneficial by relieving tension on the repaired tissue, thereby increasing durability.

AB - BACKGROUND: Stentless porcine extracellular matrix tricuspid tubular valves have been developed for tricuspid valve reconstruction. The purpose of this study was to compare biomechanical and functional performance of native and tube graft valves in an acute porcine model.METHODS: Twenty-two 65-kg pigs were randomized to tube graft or control with native valve preservation. Anterior papillary muscle force was measured with a dedicated force transducer. Microtip pressure catheters were placed in the right atrium and ventricle. Leaflet motion and three-dimensional valve geometry were evaluated using 13 sonomicrometry crystals: six in the tricuspid annulus, one on each leaflet free edge, one on each papillary muscle tip, and one in the right ventricular apex.RESULTS: No regurgitation and no significant differences in intracavitary pressures, annular motion, or leaflet excursion angles were observed after tube graft implantation (p > 0.05). Compared with the native valve, the tricuspid annulus, leaflet orifice area, annular diameters, and the septal segment of the annulus were significantly smaller in the tube graft group (p < 0.05). Maximum anterior papillary muscle force was significantly lower in the tube graft group (p < 0.005). The implantation technique led to an annular circumferential downsizing of 20% ± 17%.CONCLUSIONS: An extracellular matrix tube graft implanted in the tricuspid position produces a competent valve with physiologic performance that, despite downsizing, makes the tube graft an attractive alternative to valve replacement. The downsizing of the implantation should be considered when planning tube graft size and may be potentially beneficial by relieving tension on the repaired tissue, thereby increasing durability.

KW - Animals

KW - Atrial Pressure/physiology

KW - Biomechanical Phenomena

KW - Disease Models, Animal

KW - Extracellular Matrix

KW - Imaging, Three-Dimensional

KW - Prosthesis Design

KW - Swine

KW - Tricuspid Valve/pathology

KW - Tricuspid Valve Insufficiency/physiopathology

KW - Ventricular Pressure/physiology

U2 - 10.1016/j.athoracsur.2015.06.043

DO - 10.1016/j.athoracsur.2015.06.043

M3 - Journal article

C2 - 26365673

VL - 101

SP - 125

EP - 132

JO - The Annals of Thoracic Surgery

JF - The Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -