4D-flow cardiac magnetic resonance imaging after aortic root replacement with long-valved decellularized aortic homografts: comparison to valve-sparing aortic root replacement and healthy controls

Abstract

OBJECTIVES Long-valved decellularized aortic homografts (DAH) may be used in young patients to treat aortic valve disease associated with aortic root dilatation, thereby eliminating the need for prosthetic material and anticoagulation. METHODS Thirty-three male subjects in 3 equally sized cohorts were compared: patients following DAH implantation with a median age of 29 years [interquartile range (IQR) 27.5–37.5], patients post-valve-sparing aortic root replacement (VSARR), median 44 years (IQR 31.5–49) and healthy controls, median 33 years (IQR 28–40, P = 0.228). Time-resolved three-dimensional phase-contrast cardiac magnetic resonance imaging was performed to assess maximum blood flow velocity, pulse wave velocity, mechanical energy loss (EL), wall shear stress and flow patterns (vorticity, eccentricity, helicity) in 5 different planes of the aorta. RESULTS The mean time between surgery and cardiovascular magnetic resonance was 2.56 ± 2.0 years in DAH vs 2.67 ± 2.1 in VSARR, P = 0.500. No significant differences in maximum velocity and pulse wave velocity were found between healthy controls and DAH across all planes. Velocity in the proximal aorta was significantly higher in VSARR (182.91 ± 53.91 cm/s, P = 0.032) compared with healthy controls. EL was significantly higher in VSARR in the proximal aorta with 1.85 mW (IQR 1.39–2.95) compared with healthy controls, 1.06 mW (0.91–1.22, P = 0.016), as well as in the entire thoracic aorta. In contrast, there was no significant EL in DAH in the proximal, 1.27 m/W (0.92–1.53, P = 0.296), as well as in the thoracic aorta, 7.7 m/W (5.25–9.90, P = 0.114), compared with healthy controls. There were no significant differences in wall shear stress parameters for all 5 regions of the thoracic aorta between the 3 groups. DAH patients, however, showed more vorticity, helicity and eccentricity in the ascending aorta compared with healthy controls (P < 0.019). CONCLUSIONS Decellularized long aortic homografts exhibit near to normal haemodynamic parameters 2.5 years postoperatively compared with healthy controls and VSARR.

Paediatric aortic valve replacement using decellularized allografts: a multicentre update following 143 implantations and five-year mean follow-up

“…Decellularized aortic homografts (DAH) have the potential to be less immunogenic [ 13 ] and early results have demonstrated significantly better freedom from adverse events than conventional cryopreserved aortic homografts. DAH results are comparable to those for Ross operations, achieving normal haemodynamics without the need to remove the pulmonary valve [ 14 , 15 ].…”

Five-year results from a prospective, single-arm European trial on decellularized allografts for aortic valve replacement—the ARISE Study and ARISE Registry Data

“…Decellularized aortic homografts (DAH) may provide an additional AVR option for very young patients as they can potentially address the high failure rates of conventional allogenic and xenogeneic AVR prostheses [ 12 , 13 ]. The near-normal haemodynamics in combination with the ability to repair a malfunctioning aortic root are especially important for patients with impaired myocardial function and patients with multiple previous aortic valve procedures [ 14 ]. Recent studies, however, suggested that an immunological, antibody-mediated response is present in almost all patients, which appears to be highly individual in terms of intensity [ 15 , 16 ].…”

Aortic Valve Replacement in Adult Patients with Decellularized Homografts: A Single-Center Experience

“…Decellularized homografts (DH) have been used since the early 2000s and have already shown good outcomes in younger patients with respect to survival and hemodynamic performance [14][15][16][17]. Compared to conventional homografts, different schemes of enzymatic and detergent removal of the donor cells are applied to reduce the immunogenicity of the homograft, potentially increasing the durability of the valve [18].…”