Biomechanical characterization and comparison of different aortic root surgical techniques

Bechsgaard, Tommy; Lindskow, Thomas; Lading, Troels; Røpcke, Diana Mathilde; Nygaard, Hans; Johansen, Peter; Nielsen, Sten Lyager; Hasenkam, J. Michael

doi:10.1093/icvts/ivy187

Cited by 3 publications

(2 citation statements)

References 18 publications

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“… 3 Some studies have suggested that the remodeling technique, which also spares the shape of the sinuses of Valsalva, results in more natural aortic root biomechanics. 4 , 5 However, reimplantation of the aortic valve addresses annular dilation and externally supports any remaining abnormal valvular tissue, and in some series, demonstrates greater long-term durability. 6 – 8 …”

mentioning

confidence: 99%

Comprehensive Ex Vivo Comparison of 5 Clinically Used Conduit Configurations for Valve-Sparing Aortic Root Replacement Using a 3-Dimensional–Printed Heart Simulator

et al. 2020

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Background: Many graft configurations are clinically used for valve-sparing aortic root replacement, some specifically focused on recapitulating neosinus geometry. However, the specific impact of such neosinuses on valvular and root biomechanics and the potential influence on long-term durability are unknown. Methods: Using a custom 3-dimenstional–printed heart simulator with porcine aortic roots (n=5), the anticommissural plication, Stanford modification, straight graft (SG), Uni-Graft, and Valsalva graft configurations were tested in series using an incomplete counterbalanced measures design, with the native root as a control, to mitigate ordering effects. Hemodynamic and videometric data were analyzed using linear models with conduit as the fixed effect of interest and valve as a fixed nuisance effect with post hoc pairwise testing using Tukey’s correction. Results: Hemodynamics were clinically similar between grafts and control aortic roots. Regurgitant fraction varied between grafts, with SG and Uni-Graft groups having the lowest regurgitant fractions and anticommissural plication having the highest. Root distensibility was significantly lower in SG versus both control roots and all other grafts aside from the Stanford modification ( P ≤0.01 for each). All grafts except SG had significantly higher cusp opening velocities versus native roots ( P <0.01 for each). Relative cusp opening forces were similar between SG, Uni-Graft, and control groups, whereas anticommissural plication, Stanford modification, and Valsalva grafts had significantly higher opening forces versus controls ( P <0.01). Cusp closing velocities were similar between native roots and the SG group, and were significantly lower than observed in the other conduits ( P ≤0.01 for each). Only SG and Uni-Graft groups experienced relative cusp closing forces approaching that of the native root, whereas relative forces were >5-fold higher in the anticommissural plication, Stanford modification, and Valsalva graft groups. Conclusions: In this ex vivo modeling system, clinically used valve-sparing aortic root replacement conduit configurations have comparable hemodynamics but differ in biomechanical performance, with the straight graft most closely recapitulating native aortic root biomechanics.

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confidence: 99%

Comprehensive Ex Vivo Comparison of 5 Clinically Used Conduit Configurations for Valve-Sparing Aortic Root Replacement Using a 3-Dimensional–Printed Heart Simulator

et al. 2020

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“…Various surgical techniques have been used to repair a dilated aortic root [ 9 – 13 ], all aiming at finding the ideal method to stabilize the aortic root in an effective and durable manner, as well as reestablishing biomechanical properties similar to the native aortic root [ 13 , 14 ]. It has previously been shown that a flexible aortic root is essential for the natural physiological movement of the aortic valve leaflets and the aortic annulus [ 15 ].…”

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confidence: 99%

Novel Expansible Aortic Annuloplasty Ring Exhibits Similar Characteristics as the Dacron Ring—an In Vitro Evaluation

Noor

Benhassen

Kaspersen

et al. 2023

J. of Cardiovasc. Trans. Res.

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An increasing body of research indicates that annular stability plays a key role for a successful aortic valve repair. The aim of this study was to evaluate and compare a novel open aortic annuloplasty ring (the A-ring) with the Dacron ring. Both rings were compared with native aortic roots in vitro. Eighteen aortic roots were included in the study and randomized into three groups: the native, Dacron, and A-ring group. The roots were evaluated in an in vitro physiologic pulsatile model simulating the left side of the heart. Aortic annulus diameters were significantly reduced both in the Dacron ring group (p = 0.003) and the A-ring group (p = 0.020) when compared with the native group. Both the Dacron ring and A-ring effectively downsized the aortic annulus diameter. The A-ring also displayed an ability to maintain aortic root distensibility during the cardiac cycle equally to the Dacron ring. Graphical abstract

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The importance of collagen composition and biomechanics for the porcine aortic root

Salvig

Benhassen

Nygaard

et al. 2020

Journal of Biomechanics

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Biomechanical characterization and comparison of different aortic root surgical techniques

Cited by 3 publications

References 18 publications

Comprehensive Ex Vivo Comparison of 5 Clinically Used Conduit Configurations for Valve-Sparing Aortic Root Replacement Using a 3-Dimensional–Printed Heart Simulator

Comprehensive Ex Vivo Comparison of 5 Clinically Used Conduit Configurations for Valve-Sparing Aortic Root Replacement Using a 3-Dimensional–Printed Heart Simulator

Novel Expansible Aortic Annuloplasty Ring Exhibits Similar Characteristics as the Dacron Ring—an In Vitro Evaluation

The importance of collagen composition and biomechanics for the porcine aortic root

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