Impact of Tricuspid Annuloplasty Device Shape and Size on Valve Mechanics: A Virtual Case Study

"Tricuspid valve disease affects 1.6 million Americans [1]. The primary surgical treatment for tricuspid valve disease is the implantation of annuloplasty devices – ring like devices which come in various shapes and sizes. However, selection of ring size and shape are often motivated by surgeon preference rather than scientific rationale. We used our subject-specific finite element model of the human tricuspid valve, the Texas TriValve 1.0 [2], to conduct a virtual case study in order to understand the impact of device size and shape on valve mechanics and provide a rational basis for device selection. To this end, we implanted four different annuloplasty devices of six different sizes in our virtual patient. All finite element simulations were solved using the Texas Advance Computing Center’s Stampede2 supercomputer. After each virtual surgery, we computed the coaptation area, leaflet end-systolic angles, leaflet stress, and chordal forces. In Figure 1 we see the results of a baseline simulation of our healthy and diseased Texas TriValve. Figure 2 shows the outcome of all 24 virtual repair cases. Our results showed the choice of device shape and size significantly impacts valve mechanics. We found that the one flat device, the Edwards Classic, maximized coaptation area and minimized leaflet stress and chordal forces while the contoured devices were better at normalizing end-systolic angles. Further, we found reducing device size increased coaptation area while negatively impacting stress, chordal forces, and end-systolic angles. Our case study demonstrates the potential impact of device shape and size on valve mechanics. Further expanding our study to more valves may allow for universal recommendations in the future. [1] Nath, J. et al., JACC, 43:405-409, 2004. [2] Mathur, M. et. al., Eng with Comp, 38:3835-3848, 2022."Texas Advanced Computing Center (TACC