Annals of Biomedical Engineering

, Volume 40, Issue 3, pp 750-761

First online:

Mitral Valve Annuloplasty

A Quantitative Clinical and Mechanical Comparison of Different Annuloplasty Devices
  • Manuel K. RauschAffiliated withDepartment of Mechanical Engineering, Stanford University
  • , Wolfgang BotheAffiliated withDepartment of Cardiothoracic Surgery, Stanford University
  • , John-Peder Escobar KvittingAffiliated withDepartment of Cardiothoracic Surgery, Stanford University
  • , Julia C. SwansonAffiliated withDepartment of Cardiothoracic Surgery, Stanford University
  • , D. Craig MillerAffiliated withDepartment of Cardiothoracic Surgery, Stanford University
  • , Ellen KuhlAffiliated withDepartment of Mechanical Engineering, Stanford UniversityDepartment of Cardiothoracic Surgery, Stanford UniversityDepartment of Bioengineering, Stanford University Email author 

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Mitral valve annuloplasty is a common surgical technique used in the repair of a leaking valve by implanting an annuloplasty device. To enhance repair durability, these devices are designed to increase leaflet coaptation, while preserving the native annular shape and motion; however, the precise impact of device implantation on annular deformation, strain, and curvature is unknown. In this article, we quantify how three frequently used devices significantly impair native annular dynamics. In controlled in vivo experiments, we surgically implanted 11 flexible-incomplete, 11 semi-rigid-complete, and 12 rigid-complete devices around the mitral annuli of 34 sheep, each tagged with 16 equally spaced tantalum markers. We recorded four-dimensional marker coordinates using biplane videofluoroscopy, first with device and then without, which were used to create mathematical models using piecewise cubic splines. Clinical metrics (characteristic anatomical distances) revealed significant global reduction in annular dynamics upon device implantation. Mechanical metrics (strain and curvature fields) explained this reduction via a local loss of anterior dilation and posterior contraction. Overall, all three devices unfavorably caused reduction in annular dynamics. The flexible-incomplete device, however, preserved native annular dynamics to a larger extent than the complete devices. Heterogeneous strain and curvature profiles suggest the need for heterogeneous support, which may spawn more rational design of annuloplasty devices using design concepts of functionally graded materials.


Mitral annulus Mitral regurgitation Annuloplasty Strain Curvature Dynamics