Key result
Contoured annuloplasty devices normalize angles in virtual models, whereas flat devices maximize coaptation and minimize stress.
Why the study?
Annuloplasty device shape and size choices are often guided by surgical intuition rather than scientific rationale, creating a need to evaluate their impact on valve mechanics.
Does tricuspid annuloplasty device shape and size impact valve mechanics in a computational model?
Does tricuspid annuloplasty device shape and size impact valve mechanics in a computational model?
Computational modeling demonstrates that tricuspid annuloplasty device shape and size significantly impact valve mechanics, highlighting the potential for patient-specific virtual surgical planning.
May guide device selection in computational tricuspid models; leaves open clinical translation and patient outcomes.
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
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Haese et al. (2023) studied Tricuspid valve disease (n=1). Tricuspid annuloplasty devices (4 shapes, 6 sizes) vs. Different device shapes and sizes was evaluated on Coaptation area, leaflet end-systolic angles, leaflet stress, and chordal forces. Contoured annuloplasty devices better normalized end-systolic angles in a virtual patient, while a flat device maximized coaptation area and minimized leaflet stress and chordal forces.
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