# Optimized Mitral Annuloplasty

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2021 · $758,432

## Abstract

Contact PD/PI: GORMAN, JOSEPH
Ischemic Mitral Regurgitation (IMR) is a major clinical problem. Our group has demonstrated that IMR is a
heterogeneous disease with two general subpopulations.(1) In one group, IMR results from moderate annular
dilatation and profound leaflet tethering. We have shown these patients are best treated by valve replacement.(1,
2) In the second subpopulation, IMR is the result of severe annular dilatation (i.e. minimal leaflet tethering). Here,
ring annuloplasty has been shown to be an effective treatment, provided the ring remains anchored to the
annulus. The Achilles heel of these repairs is the higher suture forces required to downsize these large annuli,
which predisposes to dehiscence. Ring dehiscence is estimated to underlie 13- 42% of reoperations for
procedure-related repair failures.(3-5) Dehiscence occurs when the suture holding strength of the local tissue is
exceeded by the force on the suture. We have developed novel transducers to measure ring suture force and
quantified the effects of ring type, sizing, suture position, annular histology, and holding strength on dehiscence
likelihood.(6-9) These studies have mechanistically demonstrated that ring flexibility significantly reduces suture
forces, specifically in the weakest region of annular tissue. These results suggest that the incorporation of
segmental ring flexibility to the already known functional benefits of saddle shape will produce IMR-specific rings
that restore valve geometry while reducing dehiscence likelihood even in the setting of suboptimal suture
placement. To this end, the following specific aims have been designed to prove the hypothesis: In the setting
of IMR, new hybrid rigid-flexible annuloplasty rings are capable of both restoring normal valve geometry
and reducing ring suture forces to a magnitude that overcomes the effect of suboptimal suture
placement that otherwise would lead to an increased likelihood for dehiscence.

## Key facts

- **NIH application ID:** 10155588
- **Project number:** 5R01HL147256-03
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Robert C Gorman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $758,432
- **Award type:** 5
- **Project period:** 2019-04-01 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10155588

## Citation

> US National Institutes of Health, RePORTER application 10155588, Optimized Mitral Annuloplasty (5R01HL147256-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10155588. Licensed CC0.

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