Releasable annuloplasty ring insertion - a novel experimental implantation model

Wolfgang Bothe, Paul A. Chang, Julia C. Swanson, Akinobu Itoh, Koji Arata, Neil B. Ingels, David Craig Miller

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective: Experimental testing of annuloplasty ring (AR) effects requires a control group if the AR is implanted conventionally. Our goal was to develop a reversible AR insertion method that allows for beating heart assessment with and without an AR, providing the ability to evaluate the effects of an AR in the same animal (internal control). We tested the feasibility of this technique in an in vivo ovine model using four-dimensional (4-D) radiopaque marker tracking. Methods: Before the operation, a rigid AR (Edwards Geoform®, Edwards Lifesciences, Irvine, CA, USA) was prepared by stitching the middle parts of eight double-armed sutures evenly spaced through the ring fabric using a Spring Eye needle. The resulting loops were 'locked' with polypropylene sutures. In addition, two drawstring sutures were attached to the AR. Using cardiopulmonary bypass and cardioplegic arrest, 12 adult sheep had 16 radiopaque markers sewn to the mitral annulus. The AR was implanted by stitching the eight sutures equidistantly in a perpendicular direction through the mitral annulus. The sheep were transferred to the catheterisation laboratory and 4-D marker coordinates were obtained using biplane videofluoroscopy (60 Hz) with the AR inserted (Geo-AR). The locking sutures were then released, the AR was pulled up to the atrial roof using the drawstring sutures and another dataset was acquired (control). Maximum and minimum mitral annular areas (MAAmax, MAAmin) during the cardiac cycle were derived from implanted markers. Data are provided from one representative animal. Results: AR insertion and release were uneventful in all animals. Whereas the mitral annulus was dynamic in the control state (MAAmax: 9.0 cm2, MAAmin: 7.8 cm2), mitral annular dynamics were abolished in the Geo-AR case (MAAmax: 6.2 cm2, MAAmin: 6.0 cm2). Conclusions: This novel releasable AR implantation method is feasible and permits in vivo assessment of AR effects in the same heart. The new technique should facilitate experimental AR testing and promote the development of ARs based on physical criteria.

Original languageEnglish
Pages (from-to)830-832
Number of pages3
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number5
StatePublished - Nov 2009


  • Annuloplasty ring
  • Novel insertion method
  • Ovine model
  • Reversible ring implantation


Dive into the research topics of 'Releasable annuloplasty ring insertion - a novel experimental implantation model'. Together they form a unique fingerprint.

Cite this