Abstract
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.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
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.
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.
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.
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.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Sasaki, K., Iwasaki, K. (2019). ONE-POINT ADVICE: Experimental Comparison Between the Reimplantation Method and Remodeling Method. In: Kunihara, T., Takanashi, S. (eds) Aortic Valve Preservation. Springer, Singapore. https://doi.org/10.1007/978-981-13-2068-2_17
Download citation
DOI: https://doi.org/10.1007/978-981-13-2068-2_17
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-13-2067-5
Online ISBN: 978-981-13-2068-2
eBook Packages: MedicineMedicine (R0)