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