Aortic root geometry following valve-sparing root replacement with reimplantation or remodeling: experimental investigation under static continuous pressure

Abstract

The differences in aortic root geometry associated with various valve-sparing root replacement (VSRR) techniques have not fully been understood. We evaluated the root configuration of current VSRR techniques by developing in vitro test apparatus. Six fresh porcine hearts were used for each model. The aortic root remodeling control group involved replacement of the ascending aorta with diameter reduction of sino-tubular junction (STJ) (C1). The aortic valve reimplantation control group involved replacement of the ascending aorta alone (C2). VSRR included remodeling without (RM) or with annuloplasty (RM + A) and reimplantation with a tube (RI) or a handmade neo-Valsalva graft (RI + V). The root geometry of each model in response to closing hydraulic pressures of 80 and 120 mmHg was investigated using echocardiography. Among the VSRR models, RM yielded the largest aorto-ventricular junction (AVJ), which was similar to those in non-VSRR models [mean AVJ diameter (mm) at 80 mmHg; RM = 25.1 ± 1.5, RM + A = 20.9 ± 0.7, RI = 20.7 ± 0.9, RI + V = 20.8 ± 0.4]. RI + V yielded the largest Valsalva size and largest ratio of Valsalva/AVJ, which was similar to the control group [mean Valsalva diameter (mm) at 80 mmHg; RM = 28.4 ± 1.4, RM + A = 25.8 ± 1.3, RI = 23.6 ± 1.0, RI + V = 30.5 ± 0.8, ratio of Valsalva/AVJ at 80 mmHg; RM = 1.14 ± 0.06, RM + A = 1.24 ± 0.06, RI = 1.15 ± 0.06, RI + V = 1.47 ± 0.05]. The STJ diameter at 80 mmHg was numerically smaller with RM + A (22.4 ± 1.2 mm) than with RM (24.8 ± 2.3 mm, p = 0.11). There were no significant differences in AVJ, Valsalva, or STJ distensibility or ellipticity between procedures. Current modifications, including annuloplasty for remodeling or reimplantation in the setting of neo-Valsalva graft, yield near-physiological root geometries.

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Acknowledgements

This study was supported by Grant-in-Aid for Scientific Research (C) (No.15K10227) from Japan Society for the promotion of science (JSPS) and Subsidy Program for Development of International Standards for Evaluation of Innovative Medical Devices and Regenerative Medicine Products, from Ministry of Health, Labor and Welfare, Japan.

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KS: writing -original draft; investigation; data curation. TK: conceptualization; writing-review and editing; supervision; funding acquisition. HK: conceptualization. MS: data curation; investigation. HS: data curation; investigation. SS: investigation. RK: data curation; investigation. JT: data curation; investigation. MU: conceptualization. KI: conceptualization; methodology; writing-review and editing; funding acquisition; supervision.

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Correspondence to Kiyotaka Iwasaki.

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Sasaki, K., Kunihara, T., Kasegawa, H. et al. Aortic root geometry following valve-sparing root replacement with reimplantation or remodeling: experimental investigation under static continuous pressure. J Artif Organs (2021). https://doi.org/10.1007/s10047-020-01242-4

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Keywords

  • Aortic root geometry
  • Valve-sparing root replacement
  • Aortic root remodeling
  • Aortic valve reimplantation
  • In vitro investigation