ONE-POINT ADVICE: Experimental Comparison Between the Reimplantation Method and Remodeling Method

  • Kenichi Sasaki
  • Kiyotaka IwasakiEmail author


The major difference between the aortic valve reimplantation method (hereinafter referred to as reimplantation) and aortic root remodeling methods (hereinafter referred to as remodeling) is the lack of annular support in the latter. Maselli et al. modified reimplantation into remodeling in the same aortic root and found that it significantly increased the Valsalva sinus diameter and aorto-ventricular junction diameter and, conversely, decreased the effective height and coaptation height [1]. This suggests the important effect of annular support on leaflet structure. However, at present, this drawback of the remodeling method can be overcome by adding annuloplasty (AP). In contrast, when a straight graft is used, a Valsalva sinus can be formed by the remodeling method but not by the reimplantation method, which is a disadvantage of the latter. As will be explained later, the Valsalva sinus has a significant influence on leaflet stress and smooth leaflet closure. However, even with the reimplantation method, Valsalva sinuses can be formed by using the currently available graft with sinuses. Therefore, clarification of the details of the features of both operation types on valve function will lead to ingenuity and improvement of both operations, and a clinical contribution is anticipated.


  1. 1.
    Maselli D, Weltert L, Scaffa R, Nardella S, Guerrieri Wolf L, De Paulis R. Differences in aortic cusp coaptation between the reimplantation and the remodeling techniques of aortic valve-sparing surgery: an in vitro porcine model study. J Thorac Cardiovasc Surg. 2014;147(2):615–8.CrossRefGoogle Scholar
  2. 2.
    Leyh RG, Schimidke C, Sievers H-H, Yacoub MH. Opening and closing characteristics of the aortic valve after different types of valve-preserving surgery. Circulation. 1999;100:2153–60.CrossRefGoogle Scholar
  3. 3.
    Fries R, Graeter T, Aicher D, Reul H, Schmitz C, Böhm M, et al. In vitro comparison of aortic valve movement after valve-preserving aortic replacement. J Thorac Cardiovasc Surg. 2006;132(1):32–7.CrossRefGoogle Scholar
  4. 4.
    Graeter TP, Fries R, Aicher D, Reul H, Schmitz C, Schäfers HJ. In-vitro comparison of aortic valve hemodynamics between aortic root remodeling and aortic valve reimplantation. J Heart Valve Dis. 2006;15(3):329–35.PubMedGoogle Scholar
  5. 5.
    Matsumori M, Tanaka H, Kawanishi Y, Onishi T, Nakagiri K, Yamashita T, et al. 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(2):177–81.CrossRefGoogle Scholar
  6. 6.
    Grande-Allen KJ, Cochran RP, Reinhall PG, Kunzelman KS. Re-creation of sinuses is important for sparing the aortic valve: a finite element study. J Thorac Cardiovasc Surg. 2000;119:753–63.CrossRefGoogle Scholar
  7. 7.
    Beck A, Thubrikar MJ, Robicsek F. Stress analysis of the aortic valve with and without the sinuses of valsalva. J Heart Valve Dis. 2001;10:1–11.PubMedGoogle Scholar
  8. 8.
    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

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular SurgeryThe Cardiovascular InstituteTokyoJapan
  2. 2.Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women’s Medical University and Waseda UniversityTokyoJapan

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