ONE-POINT ADVICE: Optimizing Aortic Valve Repair Techniques with Computational Models
During aortic valve repair procedures, surgeons improve the function of the valve by modifying its anatomy. Such improvements are aimed at achieving sufficient coaptation area and effective height, two parameters that were identified as indicators for the long-term function of repaired aortic valves . Valve-sparing procedures, in which the aneurysmatic aortic root is replaced with a graft while retaining the native valve, give surgeons the freedom to choose both the sinotubular and aortoventricular sizes and the height of the commissures . Other types of valve repairs that involve cusp interventions also directly influence the final anatomy of the cusps. The size of the cusp needs to be chosen for various valve types and prolapse corrections , and the desired inter-commissural angle of the bicuspid aortic valve (BAV) should be decided during reimplantation  and sinus plication  procedures. Numerical models can be used as a predictive tool to estimate the mechanical performance of valves with various geometrical configurations. In this chapter, we review our numerical studies of aortic valve repair techniques and the clinically relevant conclusions that they provide.
- 4.Kari FA, Kvitting JP, Stephens EH, Liang DH, Merk DR, Fischbein MP, Mitchell RS, Miller DC. Tirone David procedure for bicuspid aortic valve disease: impact of root geometry and valve type on mid-term outcomes. Interact Cardiovasc Thorac Surg. 2014;19(3):375–81. https://doi.org/10.1093/icvts/ivu123.CrossRefPubMedGoogle Scholar
- 7.Marom G, Halevi R, Haj-Ali R, Rosenfeld M, Schafers HJ, Raanani E. Numerical model of the aortic root and valve: optimization of graft size and sinotubular junction to annulus ratio. J Thorac Cardiovasc Surg. 2013;146(5):1227–31. https://doi.org/10.1016/j.jtcvs.2013.01.030.CrossRefPubMedPubMedCentralGoogle Scholar