Suture Dehiscence in the Tricuspid Annulus: An Ex Vivo Analysis of Tissue Strength and Composition

The Annals of Thoracic Surgery
Deborah M PaulAjit P Yoganathan

Abstract

Surgical repair of functional tricuspid regurgitation (FTR) is an increasingly common practice, but annuloplasty suture dehiscence remains a significant problem. Quantitative and mechanistic understanding of annular suture holding strength can support more effective techniques for tricuspid valve device anchoring. Suture holding strength of ovine tricuspid annuli (n = 15) was quantified ex vivo by pullout testing at 12 positions around their circumference. Collagen density in additional annuli (n = 7) was quantified at positions above each commissure and midleaflet point by two-photon autofluorescence microscopy, enabling mechanistic assessment of its role in imparting suture holding strength to the tissue. Suture holding strength from pullout testing varied significantly by annular position, with a maximum of 10.0 ± 4.1 N at the septal leaflet (6 o'clock) and a minimum of 4.3 ± 1.3 N at the posterior leaflet (1 o'clock). Leaflet midpoints showed significantly higher annular tissue strength than commissures (7.2 ± 3.4 N versus 5.6 ± 2.1 N, respectively, p = 0.008). Collagen density, measured by a normalized mean pixel intensity, was significantly higher in the septal annulus than in the posterior-septal commissure, posterior an...Continue Reading

Citations

Feb 28, 2018·Cardiovascular Engineering and Technology·Avik BasuZhaoming He
Feb 7, 2018·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Jaffar M KhanRobert J Lederman
Oct 6, 2018·Biomechanics and Modeling in Mechanobiology·Immanuel David Madukauwa-DavidAjit P Yoganathan
Jun 3, 2018·Cardiovascular Engineering and Technology·Manuel K RauschTomasz A Timek
Aug 2, 2020·Cardiovascular Engineering and Technology·Fatiesa SulejmaniWei Sun
Feb 14, 2019·Cardiovascular Engineering and Technology·Shelly Singh-GryzbonAjit P Yoganathan
Oct 30, 2019·Annals of Biomedical Engineering·Mrudang MathurManuel K Rausch
Mar 13, 2019·Annals of Biomedical Engineering·Shelly Singh-GryzbonAjit P Yoganathan
Apr 1, 2021·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Jae Hong LimHo Young Hwang

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