Comparison of Two Strategies for Aortic Valve-Sparing Root Replacement

Beckmann, Erik; Leone, Alessandro; Martens, Andreas; Mariani, Carlo; Krueger, Heike; Cebotari, Serghei; Bartolomeo, Roberto Di; Haverich, Axel; Shrestha, Malakh; Pacini, Davide

doi:10.1016/j.athoracsur.2019.07.006

Cited by 15 publications

(7 citation statements)

References 19 publications

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“…The authors attributed this to spherical radial deformation of the commissures both in Valsalva grafts and ACP grafts. Whether the discrepancy in anatomy between the pulmonary autograft and aortic root leads to different outcomes of these techniques remains elusive; however, the results of the aforementioned study were in line with the previous clinical trial, 2 which strengthened our confidence in the findings of this work. In any case, a welldesigned clinical trial is warranted to verify the long-term outcomes of these modifications of the Ross procedure.…”

supporting

confidence: 83%

“…The inclusion technique using a straight Dacron graft was developed to minimize the probability of late dilation, whereas anticommissural plication (ACP), by recreating neosinus geometry, is expected to have beneficial effects on stress and hemodynamics of neoaortic valve. Given the fact that outcomes of David I procedure using a straight graft are not inferior to those performed with Valsalva prosthesis in aortic diseases, 2 the readers are looking forward to exploring whether these techniques, which originally derived from David modifications, are still effective in Ross operation. The investigation by de Kerchove and his colleagues 3 demonstrated comparable long-term outcomes and similar autograft failure between root replacement and inclusion technique in the Ross procedure.…”

mentioning

confidence: 99%

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Commentary: Live long and prosper: Enhanced biomechanics of pulmonary autograft using inclusion technique in Ross procedure

Liang

Tang

Huang

2023

The Journal of Thoracic and Cardiovascular Surgery

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supporting

confidence: 83%

mentioning

confidence: 99%

Commentary: Live long and prosper: Enhanced biomechanics of pulmonary autograft using inclusion technique in Ross procedure

Liang

Tang

Huang

2023

The Journal of Thoracic and Cardiovascular Surgery

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“…Others have found similar results comparing SGs with Valsalva grafts (VGs). 17 To elucidate why this may be occurring, we investigated these 2 conduits using an ex vivo heart simulator and found that, contrary to theory and even some 4-dimensional magnetic resonance imaging studies, the addition of neosinuses with the VG results in higher leaflet velocities and forces. 18 Based on our observations and the data we collected, we attributed the higher velocities and forces to radial, spherical displacement of the commissures in the VG.…”

mentioning

confidence: 96%

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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“…Surprisingly, the authors found that the straight graft (without neosinuses) most closely recapitulated native aortic root biomechanics. To date, no differences in clinically relevant outcomes have been demonstrated between various types of grafts for VSRR, though all studies examining this question are limited by short follow-up [18]. Until further data are collected, the available evidence suggests that despite theoretical concerns, straight Dacron grafts represent a valid and durable option for VSRR.…”

Section: Andandmentioning

confidence: 99%

Valve-sparing aortic root replacement: a primer for cardiologists

Mazine

Chu

El-Hamamsy

et al. 2022

Current Opinion in Cardiology

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Purpose of reviewThe purpose of this article is to review the contemporary evidence supporting valve-sparing aortic root replacement as the best option for patients with aortic root aneurysms and preservable aortic valves as well as to review the technical variations and modern adjuncts of these operations that impact both short and long-term durability. Recent findingsIn patients with an aortic root aneurysm, with or without aortic valve regurgitation, valve-sparing aortic root replacement provide excellent clinical outcomes and stable valve function over several decades. Successful execution of this operation depends on careful patient selection and a thorough understanding of the anatomical and physiological relationships between the various components of the aortic root. Echocardiography remains the mainstay of imaging to determine the feasibility of valve-sparing root replacement. SummaryValve-sparing aortic root replacement is an excellent alternative to composite valve graft replacement in nonelderly patients with aortic root aneurysms. Dedicated aortic root surgeons perform several technical variations of valve-sparing procedures aimed at matching the specific aortic root disorder with the optimal operation.

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Comparison of Two Strategies for Aortic Valve-Sparing Root Replacement

Cited by 15 publications

References 19 publications

Commentary: Live long and prosper: Enhanced biomechanics of pulmonary autograft using inclusion technique in Ross procedure

Commentary: Live long and prosper: Enhanced biomechanics of pulmonary autograft using inclusion technique in Ross procedure

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

Valve-sparing aortic root replacement: a primer for cardiologists

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