The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga.
The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga; Momentum PMV, Inc, Alpharetta, Ga.
J Thorac Cardiovasc Surg. 2018 Jan;155(1):131-139.e3. doi: 10.1016/j.jtcvs.2017.06.036. Epub 2017 Jun 21.
The study objective was to quantify the effect of ring type, ring-annulus sizing, suture position, and surgeon on the forces required to tie down and constrain a mitral annuloplasty ring to a beating heart.
Physio (Edwards Lifesciences, Irvine, Calif) or Profile 3D (Medtronic, Dublin, Ireland) annuloplasty rings were instrumented with suture force transducers and implanted in ovine subjects (N = 23). Tie-down forces and cyclic contractile forces were recorded and analyzed at 10 suture positions and at 3 levels of increasing peak left ventricular pressure.
Across all conditions, tie-down force was 2.7 ± 1.4 N and cyclic contractile force was 2.0 ± 1.2 N. Tie-down force was not meaningfully affected by any factor except surgeon. Significant differences in overall and individual tie-down forces were observed between the 2 primary implanting surgeons. No other factors were observed to significantly affect tie-down force. Contractile suture forces were significantly reduced by ring-annulus true sizing. This was driven almost exclusively by Physio cases and by reduction along the anterior aspect, where dehiscence is less common clinically. Contractile suture forces did not differ significantly between ring types. However, when undersizing, Profile 3D forces were significantly more uniform around the annular circumference. A suture's tie-down force did not correlate to its eventual contractile force.
Mitral annuloplasty suture loading is influenced by ring type, ring-annulus sizing, suture position, and surgeon, suggesting that reports of dehiscence may not be merely a series of isolated errors. When compared with forces known to cause suture dehiscence, these in vivo suture loading data aid in establishing potential targets for reducing the occurrence of ring dehiscence.
本研究旨在量化环的类型、环-瓣环尺寸、缝线位置和术者对在跳动心脏上结扎并约束二尖瓣成形环所需力的影响。
在绵羊模型中，对 Physio（爱德华兹生命科学公司，加利福尼亚州欧文）或 Profile 3D（美敦力，都柏林，爱尔兰）成形环进行缝线力传感器的仪器化处理，并植入 23 个心脏。记录并分析了在 10 个缝线位置和 3 个逐渐增加的左心室峰值压力水平下的结扎力和循环收缩力。
在所有条件下，结扎力为 2.7±1.4 N，循环收缩力为 2.0±1.2 N。除术者外，结扎力不受任何因素的显著影响。在 2 位主要植入术者之间观察到结扎力的总体和个体差异有显著意义。未观察到其他因素对结扎力有显著影响。与真实瓣环尺寸相比，环形-瓣环尺寸的收缩缝线力显著降低。这几乎完全由 Physio 病例引起，并且在前侧减少，在临床上瓣环切开术不太常见。环的类型对收缩缝线力没有显著影响。然而，当缩小尺寸时，Profile 3D 力在环形周长周围更加均匀。缝线的结扎力与最终的收缩力之间没有相关性。
二尖瓣成形环缝线加载受环的类型、环-瓣环尺寸、缝线位置和术者的影响，这表明瓣环切开术的愈合不良可能不仅仅是一系列孤立的错误。与已知导致缝线愈合不良的力相比，这些体内缝线加载数据有助于确定降低环切开术愈合不良发生率的潜在目标。
