The combined role of sinuses of Valsalva and flow pulsatility improves energy loss of the aortic valve

Salica, Andrea; Pisani, Giuseppe; Morbiducci, Umberto; Scaffa, Raffaele; Massai, Diana Nada Caterina; Audenino, Alberto; Weltert, Luca; Wolf, Lorenzo Guerrieri; Paulis, Ruggero De

doi:10.1093/ejcts/ezv311

Cited by 34 publications

(23 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fourdimensional magnetic resonance imaging, echo-particle image velocimetry, Doppler, and computational fluid dynamics can generate excellent flow visualizations, and many groups have studied the influence of sinuses on aortic root fluid dynamics. 5,[31][32][33][34][35][36][37][38][39][40] These studies clearly show that the sinuses of Valsalva critically influence the behavior of the aortic valve and root. Although we did not detect any meaningful differences in coronary blood flow, valve hemodynamics, or flow profiles between the conduits we compared, the benefits of neosinus creation might be overshadowed by the consequences of commissural distortion.…”

Section: Discussionmentioning

confidence: 68%

Modeling conduit choice for valve-sparing aortic root replacement on biomechanics with a 3-dimensional–printed heart simulator

Paulsen

Kasinpila

Imbrie-Moore

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Objective: The optimal conduit for valve-sparing aortic root replacement is still debated, with several conduit variations available, ranging from straight tubular grafts to Valsalva grafts. Benefits of neosinus reconstruction include enhanced flow profiles and improved hemodynamics. Curiously, however, some clinical data suggest that straight grafts may have greater long-term durability. In this study, we hypothesized that straight tubular grafts may help maintain the native cylindrical position of the aortic valve commissures radially, resulting in preserved leaflet coaptation, reduced stresses, and potentially improved valve performance.Methods: Using 3D printing, a left heart simulator with a valve-sparing root replacement model and a physiologic coronary circulation was constructed. Aortic valves were dissected from fresh porcine hearts and reimplanted into either straight tubular grafts (n ¼ 6) or Valsalva grafts (n ¼ 6). Conduits were mounted into the heart simulator and hemodynamic, echocardiographic, and high-speed videometric data were collected.Results: Hemodynamic parameters and coronary blood flow were similar between straight and Valsalva grafts, although the former were associated with lower regurgitant fractions, less peak intercommissural radial separation, preserved leaflet coaptation, decreased leaflet velocities, and lower relative leaflet forces compared with Valsalva grafts.Conclusions: Valsalva grafts and straight grafts perform equally well in terms of gross hemodyanics and coronary blood flow. Interestingly, however, the biomechanics of these 2 conduits differ considerably, with straight grafts providing increased radial commissural stability and leaflet coaptation. Further investigation into how these parameters influence clinical outcomes is warranted. (J Thorac Cardiovasc Surg 2019;158:392-403) Variation (yellow arrows) between Valsalva graft and radial position of aortic commissures. Central MessageStraight grafts maintain the radial position of the aortic valve commissures in their native cylindrical conformation, preserving leaflet coaptation and decreasing regurgitation, cusp velocities, and forces. PerspectiveValve-sparing root replacement is an effective treatment for aortic root aneurysms, although the ideal conduit is unknown. While neosinus reconstruction is believed to generate more physiologic flow profiles and optimized hemodynamics, it does not appear to increase longterm clinical durability over straight grafts. Ex vivo testing was used to provide a mechanistic comparison and demonstrated decreased cusp velocities, forces, and regurgitation in straight grafts.

show abstract

Section: Discussionmentioning

confidence: 68%

Modeling conduit choice for valve-sparing aortic root replacement on biomechanics with a 3-dimensional–printed heart simulator

Paulsen

Kasinpila

Imbrie-Moore

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…In case of VSO, the use of tube graft with neo‐SV, mimicking the native structure and dynamics, should theoretically be able to affect valve durability since perturbations of the regular movements of opening and closure of the native aortic valve and alterations in flow dynamics may be avoided . SV were also demonstrated to have a key role in optimizing the aortic hemodynamics during systole, minimizing energy losses . In addition, Weltert et al using finite element computer‐assisted stress analysis were able to show that the use of a standard tubular graft can be linked to higher stress to coronary sutures, while using a graft with preformed SV could relieve stress on the coronary anastomoses, potentially decreasing the incidence of postoperative complications such as bleeding and late pseudoaneurysm formation .…”

Section: Discussionmentioning

confidence: 99%

“…The importance of the recreation of the sinuses of Valsalva (SV) during aortic VSO remains a matter of controversy. Despite solid experimental and in vivo evidence of the physiologic importance of the SV for aortic valve function, there are limited data comparing the outcome of patients undergoing VSO with and without SV reconstruction.…”

Section: Introductionmentioning

confidence: 99%

The role of neo-sinus reconstruction in aortic valve-sparing surgery

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recently, in vitro studies also suggest that the sinuses of Valsalva (aortic sinus) play an important role in the regulation of the aortic hemodynamics. Pisani et al [32] and Salica et al [33] found that the presence of the sinuses of Valsalva increases the effective orifice area when the cardiac output increased, which helps minimize the flow energy loss during ejection.…”

Section: Introductionmentioning

confidence: 99%

An Experimental Study of Pulsatile Flow in a Compliant Aortic Root Model under Varied Cardiac Outputs

Zhang

2018

Fluids

View full text Add to dashboard Cite

The fluid dynamics of a natural aortic valve are complicated due to the highly pulsatile flow conditions, the compliant wall boundaries, and the sophisticated geometry of the aortic root. In the present study, a pulsatile flow simulator was constructed and utilized to investigate the turbulent characteristics and structural deformation of an intact silicone aortic root model under different flow inputs. Particle image velocimetry and high-frequency pressure sensors were combined to gather the pulsatile flow field information. The results demonstrated the distributions and the variations of the jet flow structures at different phases of a cardiac cycle. High turbulence kinetic energy was observed after the peak systole phase when the flow started to decelerate. Deformations of the aortic root upstream and downstream of the valve leaflets under normal boundary conditions were summarized and found to be comparable to results from clinical studies. The cardiac output plays an important role in determining the strength of hemodynamic and structural responses. A reduction in cardiac outputs resulted in a lower post-systole turbulence, smaller circumferential deformation, a smaller geometric orifice area, and a shortened valve-opening period.

show abstract

The combined role of sinuses of Valsalva and flow pulsatility improves energy loss of the aortic valve

Abstract: These findings (i) confirm the hypothesis that the sinuses of Valsalva play a key role in optimizing the aortic haemodynamics during systole, minimizing energy losses; (ii) suggest that the sinuses of Valsalva are needed because of the complex nature of blood flow during ejection.

Cited by 34 publications

References 22 publications

Modeling conduit choice for valve-sparing aortic root replacement on biomechanics with a 3-dimensional–printed heart simulator

Modeling conduit choice for valve-sparing aortic root replacement on biomechanics with a 3-dimensional–printed heart simulator

The role of neo-sinus reconstruction in aortic valve-sparing surgery

An Experimental Study of Pulsatile Flow in a Compliant Aortic Root Model under Varied Cardiac Outputs

Contact Info

Product

Resources

About