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

## TL;DR

This study tested a new biodegradable annuloplasty ring made from decellularized tendon and found it as effective as existing rings in reducing mitral regurgitation in a lab model.

## Contribution

A decellularized tendon-based annuloplasty ring was developed and shown to perform comparably to conventional rings in suppressing regurgitation.

## Key findings

- The decellularized tendon-based ring reduced regurgitation to 15.5% with no significant difference compared to commercial rings.
- Effective mitral valve area was comparable across all tested annuloplasty ring types.
- The new ring performed similarly to existing devices in a degenerative mitral regurgitation model.

## Abstract

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.

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).

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).

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

Mitral regurgitation (MR) is the most common valvular heart disease affecting approximately 24.2 million people worldwide.