Effect of a Decellularised Tendon-Based Mitral Annuloplasty Ring on Regurgitation Suppression in Degenerative Mitral Regurgitation Model: An in Vitro Pulsatile Circulation Study

Abstract OBJECTIVES Conventional annuloplasty rings used in mitral valve repair (MVr) are made of metal or synthetic polymers, which may increase infection risk. This study aimed to develop a mitral annuloplasty ring using decellularised tissue and evaluate its ability to suppress regurgitation in a degenerative mitral regurgitation (DMR) model. METHODS A 4 mm diameter annuloplasty ring was created using decellularized bovine tendon. Porcine mitral valve complexes (including the annulus, leaflets, chordae tendineae, and papillary muscles) were obtained from a slaughterhouse. The annulus was enlarged by 4 mm, and the two chordae tendineae of the posterior leaflet (P2) were severed. The DMR model, integrated into a pulsatile flow simulator, was repaired using a commercial—Physio II, Colvin-Galloway (CG) Future, Tailor band, and a decellularised tendon-based ring. Regurgitation control and effective mitral valve area (MVA) were compared (n = 6 for each group). RESULTS The regurgitation rate of the DMR model was 52.3 ± 3.4%, consistent with severe MR. Post-MVr with each ring, the regurgitation rates were 14.9 ± 3.1% (Physio II), 14.5 ± 1.1% (CG Future), 16.4 ± 1.7% (Tailor band), and 15.5 ± 3.0% (decellularised tendon-based biological ring). All of these rates were significantly reduced, with no significant differences among them. Effective MVA was comparable across groups: 2.46 ± 0.28 cm2 (Physio II), 2.33 ± 0.54 cm2 (CG Future), 2.28 ± 0.12 cm2 (Tailor band), and 2.27 ± 0.53 cm2 (decellularised tendon-based biological ring). CONCLUSIONS The decellularised tendon-based annuloplasty ring demonstrated functional performance comparable to that of current mitral annuloplasty devices.