Effect of a Decellularized Tendon-Based Mitral Annuloplasty Ring on Regurgitation Suppression in Degenerative Mitral Regurgitation Model: An In Vitro Pulsatile Circulation Study.

OBJECTIVES

Conventional annuloplasty rings used in mitral valve repair (MVr) are made of metal or synthetic polymers, which may increase infection risk. This study aimed to develop a mitral annuloplasty ring using decellularized tissue and evaluate its ability to suppress regurgitation in a degenerative mitral regurgitation (DMR) model.

METHODS

A 4 mm diameter annuloplasty ring was created using decellularized bovine tendon. Porcine mitral valve complexes (including the annulus, leaflets, chordae tendineae, and papillary muscles) were obtained from a slaughterhouse. The annulus was enlarged by 4 mm, and the 2 chordae tendineae of the posterior leaflet (P2) were severed. The DMR model, integrated into a pulsatile flow simulator, was repaired using a commercial-Physio II, Colvin-Galloway (CG) Future, Tailor band, and a decellularized tendon-based ring. Regurgitation control and effective mitral valve area (MVA) were compared (n = 6 for each group).

RESULTS

The regurgitation rate of the DMR model was 52.3 ± 3.4%, consistent with severe MR. Post-MVr with each ring, the regurgitation rates were 14.9 ± 3.1% (Physio II), 14.5 ± 1.1% (CG Future), 16.4 ± 1.7% (Tailor band), and 15.5 ± 3.0% (decellularized tendon-based biological ring). All of these rates were significantly reduced, with no significant differences among them. Effective MVA was comparable across groups: 2.46 ± 0.28 cm2 (Physio II), 2.33 ± 0.54 cm2 (CG Future), 2.28 ± 0.12 cm2 (Tailor band), and 2.27 ± 0.53 cm2 (decellularized tendon-based biological ring).

CONCLUSIONS

The decellularized tendon-based annuloplasty ring demonstrated functional performance comparable to that of current mitral annuloplasty devices.