title: Suture forces in undersized mitral annuloplasty: novel device and measurements.
abstract: OBJECTIVE
  To demonstrate the first use of a novel technology for quantifying suture forces on annuloplasty rings to better understand the mechanisms of ring dehiscence.
  
  
  METHODS
  Force transducers were developed, attached to a size 24 Physio ring, and implanted in the mitral annulus of an ovine animal. Ring suture forces were measured after implantation and for cardiac cycles reaching peak left ventricular pressures (LVP) of 100, 125, and 150 mm Hg.
  
  
  RESULTS
  After implantation of the undersized ring to the flaccid annulus, the mean suture force was 2.0±0.6 N. During cyclic contraction, the anterior ring suture forces were greater than the posterior ring suture forces at peak LVPs of 100 mm Hg (4.9±2.0 N vs 2.1±1.1 N), 125 mm Hg (5.4±2.3 N vs 2.3±1.2 N), and 150 mm Hg (5.7±2.4 N vs 2.4±1.1 N). The largest force was 7.4 N at 150 mm Hg.
  
  
  CONCLUSIONS
  The preliminary results demonstrate trends in annuloplasty suture forces and their variation with location and LVP. Future studies will significantly contribute to clinical knowledge by elucidating the mechanisms of ring dehiscence while improving annuloplasty ring design and surgical repair techniques.
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Siefert
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Pierce
authors.affiliation: Gorman Cardiovascular Research Group, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Madonna
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Morten Ø
authors.initials: MØ
authors.lastname: Jensen
authors.affiliation: Gorman Cardiovascular Research Group, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Chikashi
authors.initials: C
authors.lastname: Aoki
authors.affiliation: Gorman Cardiovascular Research Group, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takebayashi
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
authors.forename: Joan
authors.initials: J
authors.lastname: Fernandez Esmerats
authors.affiliation: Gorman Cardiovascular Research Group, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.affiliation: Gorman Cardiovascular Research Group, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia. Electronic address: ajit.yoganathan@bme.gatech.edu.
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Yoganathan
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D006350:Heart Valve Prosthesis; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012756:Sheep; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D014159:Transducers