title: Functional and Biomechanical Performance of Stentless Extracellular Matrix Tricuspid Tube Graft: An Acute Experimental Porcine Evaluation.
abstract: BACKGROUND
  Stentless porcine extracellular matrix tricuspid tubular valves have been developed for tricuspid valve reconstruction. The purpose of this study was to compare biomechanical and functional performance of native and tube graft valves in an acute porcine model.
  
  
  METHODS
  Twenty-two 65-kg pigs were randomized to tube graft or control with native valve preservation. Anterior papillary muscle force was measured with a dedicated force transducer. Microtip pressure catheters were placed in the right atrium and ventricle. Leaflet motion and three-dimensional valve geometry were evaluated using 13 sonomicrometry crystals: six in the tricuspid annulus, one on each leaflet free edge, one on each papillary muscle tip, and one in the right ventricular apex.
  
  
  RESULTS
  No regurgitation and no significant differences in intracavitary pressures, annular motion, or leaflet excursion angles were observed after tube graft implantation (p > 0.05). Compared with the native valve, the tricuspid annulus, leaflet orifice area, annular diameters, and the septal segment of the annulus were significantly smaller in the tube graft group (p < 0.05). Maximum anterior papillary muscle force was significantly lower in the tube graft group (p < 0.005). The implantation technique led to an annular circumferential downsizing of 20% ± 17%.
  
  
  CONCLUSIONS
  An extracellular matrix tube graft implanted in the tricuspid position produces a competent valve with physiologic performance that, despite downsizing, makes the tube graft an attractive alternative to valve replacement. The downsizing of the implantation should be considered when planning tube graft size and may be potentially beneficial by relieving tension on the repaired tissue, thereby increasing durability.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, and Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: dmr@dadlnet.dk.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Ropcke
authors.affiliation: Department of Clinical Medicine, and Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Christine
authors.initials: C
authors.lastname: Ilkjær
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, and Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Søren N
authors.initials: SN
authors.lastname: Skov
authors.affiliation: Department of Clinical Medicine, and Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Marcell J
authors.initials: MJ
authors.lastname: Tjørnild
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Anders V
authors.initials: AV
authors.lastname: Sørensen
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, and Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Jensen
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Morten O J
authors.initials: MO
authors.lastname: Jensen
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, and Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Vibeke E
authors.initials: VE
authors.lastname: Hjortdal
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, and Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Sten L
authors.initials: SL
authors.lastname: Nielsen
mesh_terms: D000818:Animals; D062185:Atrial Pressure / Q000502:physiology*; D001696:Biomechanical Phenomena; D004195:Disease Models, Animal; D005109:Extracellular Matrix; D021621:Imaging, Three-Dimensional; D011474:Prosthesis Design; D013552:Swine; D014261:Tricuspid Valve / Q000473:pathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D017725:Ventricular Pressure / Q000502:physiology*