Conformational changes during in vitro balloon fracture of internal aortic annuloplasty ring

Sandeep N. Bharadwaj, Tom X. Liu, Keith B. Allen, Christopher K. Mehta, James Flaherty, S. Christopher Malaisrie*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: HAART 300 300 (BioStable Science and Engineering, Inc) aortic annuloplasty rings restore physiologic annular geometry during aortic valve repair. Transcatheter valve-in-ring implantation is appealing for recurrent valve dysfunction but may necessitate balloon fracture of downsized annuloplasty rings. We characterized the feasibility of ring fracture and changes in ring geometry preceding fracture. Methods: The 19-mm, 21-mm, and 23-mm HAART 300 annuloplasty rings were obtained, and 23-mm, 24-mm, 25-mm, and 26-mm valvuloplasty balloons were obtained. Under continuous fluoroscopy and video recording, a 23-mm balloon was inflated within a 19-mm ring at 1 atm/s until ring fracture or balloon failure occurred. If balloon failure occurred, experiments were sequentially repeated with 1-mm upsized balloons until ring fracture occurred or no larger-sized balloons were available. Results: Upon balloon inflation, all rings exhibited an irreversible conformational change from an elliptical, annular geometry to a circular shape with ring posts flaring outward. A 23-mm balloon burst at 21 atm without fracturing the 19-mm ring. The 24-mm balloon fractured the 19-mm ring at 15 atm. Likewise, a 24-mm balloon ruptured at 18 atm without fracturing the 21-mm annuloplasty ring. A 25-mm balloon fractured the 21-mm ring at 18 atm. Finally, a 26-mm balloon burst at 20 atm without fracturing a 23-mm annuloplasty ring, but it did elicit the confirmational changes described. All fractures occurred along the upslope of a ring post. The exposed metal frame was visible after the 21-mm ring fracture. Conclusions: Fracture of HAART 300 aortic annuloplasty rings is possible with an oversized, high-pressure balloon. However, the geometrical changes in the ring and subsequent rupture of its fabric covering may be obstacles to safe, in vivo ring fracture.

Original languageEnglish (US)
Pages (from-to)24-29
Number of pages6
JournalJTCVS Techniques
Volume20
DOIs
StatePublished - Aug 2023

Funding

Funding provided by BioStable Science and Engineering, Inc, Austin, Tex.K.B.A.: Edwards, Medtronic, Abbott, Zimmer Biomet: research support, speaker bureau, proctoring with all payments to the institution and none to me personally. C.K.M.: Gore: Funding and speaking fees. S.C.M.: Edwards Lifesciences, Medtronic, Terumo Aortic, Artivion: consultant and research. All other authors reported no conflicts of interest.

Keywords

  • HAART 300 annuloplasty ring
  • aortic annuloplasty ring
  • aortic valve repair
  • ring fracture
  • valve-in-ring

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Surgery

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