The effect of tricuspid annuloplasty ring shape and size on tricuspid valve repair

A leaking tricuspid valve affects nearly 1.6 million Americans which carries high rates of morbidity and mortality. Unfortunately, existing valve repair strategies are suboptimal with up to 30% of patients exhibiting recurrent regurgitation following intervention. Computer models offer a valuable tool to better understand the tricuspid valve and work towards better surgical outcomes. To this end, we previously developed a high-fidelity patient-specific finite element model of the human tricuspid valve. In addition to faithfully capturing the kinetics and kinematics of the healthy valve, it can also simulate disease progression by mirroring functional tricuspid regurgitation. In this work, we virtually repair the diseased valve using 24 different rigid annuloplasty rings. After simultaneously simulating the repair procedure, we report clinical and mechanical measures to offer insight in to the advantages and disadvantages of each ring. We show ring size and shape play a significant role in predicting the post-repair mechanical outcome of the valve. That is, the measures differ after implanting contoured and flat rings. Interestingly, stress in the anterior leaflet appears to be invariant to the choice of ring size or shape. For this specific valve, excessive undersizing did not appear to negatively impact immediate post-repair outcomes. Importantly, this study highlights the significance of proper ring choice and hopes to spur further study and development of proper sizing strategies. Additionally, our model and data are openly available and will hopefully allow for further virtual experiments to better understand and optimize tricuspid valve repair for improved patient outcomes.Engineering Mechanic