Impact of tricuspid annuloplasty device shape and size on valve mechanics—a computational study

• Published in: JTCVS open Vol. 17; pp. 111 - 120
• Main Authors: Haese, Collin E., Mathur, Mrudang, Lin, Chien-Yu, Malinowski, Marcin, Timek, Tomasz A., Rausch, Manuel K.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.02.2024; Elsevier
• Subjects: Adult: Tricuspid Valve; annuloplasty; functional regurgitation; repair; tricuspid valve; virtual surgery; annuloplasty; functional regurgitation; repair; virtual surgery; tricuspid valve
• ISSN: 2666-2736; 2666-2736
• DOI: 10.1016/j.xjon.2023.11.002

Tricuspid valve disease significantly affects 1.6 million Americans. The gold standard treatment for tricuspid disease is the implantation of annuloplasty devices. These ring-like devices come in various shapes and sizes. Choices for both shape and size are most often made by surgical intuition rather than scientific rationale. To understand the impact of shape and size on valve mechanics and to provide a rational basis for their selection, we used a subject-specific finite element model to conduct a virtual case study. That is, we implanted 4 different annuloplasty devices of 6 different sizes in our virtual patient. After each virtual surgery, we computed the coaptation area, leaflet end-systolic angles, leaflet stress, and chordal forces. We found that contoured devices are better at normalizing end-systolic angles, whereas the one flat device, the Edwards Classic, maximized the coaptation area and minimized leaflet stress and chordal forces. We further found that reducing device size led to increased coaptation area but also negatively impacted end-systolic angles, stress, and chordal forces. Based on our analyses of the coaptation area, leaflet motion, leaflet stress, and chordal forces, we found that device shape and size have a significant impact on valve mechanics. Thereby, our study also demonstrates the value of simulation tools and device tests in “virtual patients.” Expanding our study to many more valves may, in the future, allow for universal recommendations. The Texas TriValve 1.0, a high-fidelity patient-specific model of the human tricuspid valve, was modified to induce functional tricuspid regurgitation. Twenty-four virtual annuloplasty surgeries were conducted to investigate the impact of device shape and size on repair outcomes. The contoured devices were better at restoring end-systolic leaflet angles whereas the flat device maximized coaptation area and minimized leaflet stress and chordal forces. In all virtual repairs, annuloplasty device shape and size had a significant impact on tricuspid valve mechanics. [Display omitted]