Advertisement

Effect of Aortic Root Repair on Aortic Valve Function

  • Michael ScharfschwerdtEmail author
Chapter

Abstract

The structures of the native aortic root and valve perform very sophisticated movements during the heart cycle, interacting with each other to optimize ventricular-arterial coupling warranting hemodynamic efficiency and reducing stress on the cusps. This remarkable functionality is based on the particular geometry of the aortic root and the elastic behaviors of the aortic wall as well as the aortic annulus. In ascending aorta replacement including root reconstruction, the so-called valve-sparing procedures, the balance of this subtle adjusted system may be impaired in different manners, depending on the particular type of procedure, the behaviors of the prosthesis, and also the implementation of an accurate geometry.

Keywords

Aortic valve Valve repair Root Sinotubular junction Root distensibility Geometry Leaflet stress 

References

  1. 1.
    David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617–21.PubMedGoogle Scholar
  2. 2.
    Sarsam MA, Yacoub M. Remodeling of the aortic valve annulus. J Thorac Cardiovasc Surg. 1993;105:435–8.PubMedGoogle Scholar
  3. 3.
    Fries R, Graeter T, Aicher D, Reul H, Schmitz C, Böhm M, Schäfers HJ. In vitro comparison of aortic valve movement after valve-sparing aortic replacement. J Thorac Cardiovasc Surg. 2006;132:32–7.CrossRefGoogle Scholar
  4. 4.
    David TE. Remodelling of aortic root and preservation of the native aortic valve. Oper Tech Card Thorac Surg. 1996;1:44–56.CrossRefGoogle Scholar
  5. 5.
    Kamohara K, Itoh T, Natsuaki M, Norita H, Naito K. Early valve failure after aortic valve-sparing root reconstruction. Ann Thorac Surg. 1999;68:257–9.CrossRefGoogle Scholar
  6. 6.
    Zehr KJ. Valve preserving aortic root reconstruction. J Thorac Cardiovasc Surg. 2001;121:1220–1.Google Scholar
  7. 7.
    Cochran RP, Kunzelmann KS, Eddy AG, Hofer BO, Verrier ED. Modified conduit preparation creates a pseudosinus in an aortic valve-sparing procedure for aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1995;109:1049–58.CrossRefGoogle Scholar
  8. 8.
    Demers P, Miller DC. Simple modification of “T. David-V” valve-sparing aortic root replacement to create graft pseudosinuses. Ann Thorac Surg. 2004;78:1479–81.CrossRefGoogle Scholar
  9. 9.
    Gleason TE. New graft formulation and modification of the David reimplantation technique. J Thorac Cardiovasc Surg. 2005;130:601–3.CrossRefGoogle Scholar
  10. 10.
    De Paulis R, De Matteis GM, Nardi P, Scaffa R, Bassano C, Chiariello L. Analysis of valve motion after the reimplantation type of valve-sparing procedure (David I) with a new aortic root conduit. Ann Thorac Surg. 2002;74:53–7.CrossRefGoogle Scholar
  11. 11.
    Richardt D, Karluss A, Schmidtke C, Sievers HH, Scharfschwerdt M. A new sinus prosthesis for aortic valve-sparing surgery maintaining the shape of the root at systemic pressure. Ann Thorac Surg. 2010;89:943–6.CrossRefGoogle Scholar
  12. 12.
    Schmidtke C, Sievers HH, Frydrychowicz A, Petersen M, Scharfschwerdt M, Karluss A, Stierle U, Richardt D. First clinical results with the new sinus prosthesis used for valve-sparing aortic root replacement. Eur J Cardiothorac Surg. 2013;43:585–90.CrossRefGoogle Scholar
  13. 13.
    Markl M, Draney MT, Miller DC, Levin JM, Williamson EE, Pelc NJ, Liang DH, Herfkens RJ. Time-resolved three-dimensional magnetic resonance velocity mapping of aortic flow in healthy volunteers and patients after valve-sparing aortic root replacement. J Thorac Cardiovasc Surg. 2005;130:456–63.CrossRefGoogle Scholar
  14. 14.
    de Oliveira NC, David TE, Ivanov J, Armstrong S, Eriksson MJ, Rakowski H, Webb G. Results of surgery for aortic root aneurysm in patients with Marfan syndrome. J Thorac Cardiovasc Surg. 2003;125:789–96.CrossRefGoogle Scholar
  15. 15.
    Bethea BT, Torin P, Fitton TP, Alejo DE, Barreiro CJ, Cattaneo S, et al. Results of aortic valve-sparing operations: experience with remodeling and reimplantation procedures in 65 patients. Ann Thorac Surg. 2004;78:767–72.CrossRefGoogle Scholar
  16. 16.
    David TE, Feindel CM, Webb GD, Colman JM, Armstrong S, Maganti M. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardiovasc Surg. 2006;132:347–54.CrossRefGoogle Scholar
  17. 17.
    Kunihara T, Aicher D, Rodionycheva S, Groesdonk HV, Langer F, Sata F, Schäfers HJ. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg. 2012;143:1389–95.CrossRefGoogle Scholar
  18. 18.
    Erasmi A, Sievers HH, Scharfschwerdt M, Eckel T, Misfeld M. In vitro hydrodynamics, cusp bending deformation and root distensibility for different types of aortic valve sparing operations: remodeling, sinus prosthesis and reimplantation. J Thorac Cardiovasc Surg. 2005;130:1044–9.CrossRefGoogle Scholar
  19. 19.
    Monti L, Mauri G, Balzarini L, Tarelli G, Brambilla G, Vitali E, et al. Compliance of the Valsalva graft’s pseudosinuses at midterm follow-up with cardiovascular magnetic resonance. Ann Thorac Surg. 2011;91:92–6.CrossRefGoogle Scholar
  20. 20.
    Settepani F, Bergonzini M, Barbone A, Citterio E, Basciu A, Ornaghi D, Gallotti R, Tarelli G. Reimplantation valve-sparing aortic root replacement with the Valsalva graft: what have we learnt after 100 cases? Interact Cardiovasc Thorac Surg. 2009;9:113–6.CrossRefGoogle Scholar
  21. 21.
    Sripathi VC, Kumar RK, Balakrishnan KR. Further insights into normal aortic valve function: role of a compliant aortic root on leaflet opening and valve orifice area. Ann Thorac Surg. 2004;77:844–51.CrossRefGoogle Scholar
  22. 22.
    De Paulis R, De Matteis GM, Nardi P, Scaffa R, Buratta MM, Chiariello L. Opening and closing characteristics of the aortic valve after valve-sparing procedures using a new aortic root conduit. Ann Thorac Surg. 2001;72:487.CrossRefGoogle Scholar
  23. 23.
    Thubrikar MJ, Robicsek F, Gong GG, Fowler BL. A new aortic root prosthesis with compliant sinuses for valve-sparing operations. Ann Thorac Surg. 2001;71:S318–22.CrossRefGoogle Scholar
  24. 24.
    Rama A, Rubin S, Bonnet N, Gandjbakhch I. New technique of aortic root reconstruction with aortic valve annuloplasty in ascending aortic aneurysm. Ann Thorac Surg. 2007;83:1908–10.CrossRefGoogle Scholar
  25. 25.
    Leyh RG, Schmidtke C, Sievers HH, Yacoub MH. Opening and closing characteristics of the aortic valve after different types of valve-preserving surgery. Circulation. 1999;100:2153–60.CrossRefGoogle Scholar
  26. 26.
    Babin-Ebell J, Freiherr Grote H, Sievers HH, Scharfschwerdt M. Impact of graft size and commissural resuspension height on aortic valve competence in valve-sparing aortic replacement under physiological pressures. Thorac Cardiovasc Surg. 2009;57:399–402.CrossRefGoogle Scholar
  27. 27.
    Pethig K, Milz A, Hagl C, Harringer W, Haverich A. Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve failure. Ann Thorac Surg. 2002;73:29–33.CrossRefGoogle Scholar
  28. 28.
    Furukawa K, Ohteki H, Cao ZL, Narita Y, Okazaki Y, Ohtsubo S, Itoh T. Evaluation of native valve-sparing aortic root reconstruction with direct imaging - reimplantation or remodeling? Ann Thorac Surg. 2004;77:1636–41.CrossRefGoogle Scholar
  29. 29.
    Matsumori M, Tanaka H, Kawanishi Y, Onishi T, Nakagiri K, Yamashita T, Okada K, Okita Y. Comparison of distensibility of the aortic root and cusp motion after aortic root replacement with two reimplantation techniques: Valsalva graft versus tube graft. Interact Cardiovasc Thorac Surg. 2007;6:177–81.CrossRefGoogle Scholar
  30. 30.
    Higashidate M, Tamiya K, Beppu T, Imai Y. Regulation of the aortic valve opening. In vivo dynamic measurement of aortic valve orifice area. J Thorac Cardiovasc Surg. 1995;110:496–503.CrossRefGoogle Scholar
  31. 31.
    Robicsek F, Thubrikar MJ. Role of sinus wall compliance in aortic leaflet function. Am J Cardiol. 1999;84:944–6.CrossRefGoogle Scholar
  32. 32.
    Katayama S, Umetani N, Sugiura S, Hisada T. The sinus of Valsalva relieves abnormal stress on aortic valve leaflets by facilitating smooth closure. J Thorac Cardiovasc Surg. 2008;136:1528–35.CrossRefGoogle Scholar
  33. 33.
    Thubrikar M, Bosher LP, Nolan SP. The mechanism of opening of the aortic valve. J Thorac Cardiovasc Surg. 1979;77:863–70.PubMedGoogle Scholar
  34. 34.
    Scharfschwerdt M, Leonhard M, Lehmann J, Richardt D, Goldmann H, Sievers HH. In vitro investigation of a novel elastic vascular prosthesis for valve-sparing aortic root and ascending aorta replacement. Eur J Cardiovasc Surg. 2016;49:1370–3.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Cardiac and Thoracic Vascular SurgeryUniversity of LübeckLübeckGermany

Personalised recommendations